CPT Exam Study Guide

Section 1: Professional Development and

Responsibility
Chapter 1. The Modern State of Health and Fitness Summary
• The focus on scientific principles makes NASM’s systems and methodologies safe and
effective for any client working toward any fitness goal.
• NASM recommends that all fitness professionals maintain a focus on an evidence-based
practice to attain the highest levels of success.
• Evidence-based practice is the conscientious use of current best evidence in making
decisions about patient or client care.
• NASM’s proprietary approach to exercise training, the OPT model, was developed with
evidence-based practice as a core guiding philosophy.
• Acute disease is any suddenly occurring medical condition that can be treated and healed in
a short period of time.
• A chronic disease is a medical condition that persists without quickly going away or being
cured altogether.
• The terms overweight and obesity refer to a body weight that is greater than what is
considered normal or healthy for a certain height, specifically due to excess body fat.
• Being overweight or obese greatly increase the chances of developing a chronic disease.
• Cardiovascular disease is a broad term describing numerous problems of the heart and
blood vessels, including stroke, heart attacks, heart failure, heart valve problems, and
arrhythmias.
• Hypertension is one of the primary risk factors for heart disease and stroke, which are the
global leading causes of death.
• Cholesterol is a waxy substance found in the blood that is made up of a combination of
protein and fatty acids.
• Diabetes is a disease in which blood glucose levels are too high. Glucose comes from the
foods we eat.
• Insulin is a hormone produced by the pancreas that helps glucose get into cells to provide
the energy for work.
• Cancer is an abnormal growth of cells that can result from a wide range of genetic and
environmental factors.
• COPD is an umbrella term for lung diseases characterized by increased breathlessness,
airflow limitation, and accelerated decline of lung function.
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• Two of the most common issues at the foot and ankle are sprains and plantar fasciitis. An
ankle sprain occurs when a person rolls, twists, or turns an ankle, which stretches or tears
ligaments, whereas plantar fasciitis causes pain in the plantar fascia tissue located on the
underside of the foot.
• The LPHC is made up of the lumbar spine (low-back area), pelvis, abdomen, and hip
musculoskeletal structures; it is more commonly referred to as the “core.” The LPHC is an
important anatomical structure because it connects the upper and lower halves of a
person’s body.
• Shoulder dysfunction is very common in the greater population, especially in those who
frequently lift objects overhead.
• Regular exercise and increased physical activity have been frequently shown by research to
improve numerous types of musculoskeletal dysfunction and chronic disease.
• Understanding the scopes of practice for all adjacent allied health professionals, as well as
all relevant local laws and regulations, will ensure CPTs are always working within their own
scope of practice.
• Networking with other allied health professionals and certified fitness professionals can
lead to great levels of success in the fitness industry.
• An NASM-CPT must always adhere to the NASM Code of Professional Conduct.
Important Concepts (not an exhaustive list)
Body Mass Index** very • <18.5 = underweight
important • 18.5-24.9 = healthy weight
• 25-29.9 = overweight
• 30-34.9 = obese
• 35-39.9 = obese II
• >40 = obese III
Blood Pressure** very • Normal (healthy): Less than 120/80 mm Hg
important • Elevated: Systolic between 120 and 129 and diastolic less than
80 mm Hg
• Stage 1 hypertension: Systolic between 130 and 139 or diastolic
between 80 and 89 mm Hg
• Stage 2 hypertension: Systolic 140 or higher or diastolic 90 mm
Hg or higher
• Hypertensive crisis: Systolic greater than 180 and/or diastolic
greater than 120 mm Hg
LDL Cholesterol • LDL cholesterol, sometimes referred to as “bad cholesterol,”
tends to increase the risk of cardiovascular disease. LDLs,
specifically, are the form of cholesterol that makes up the
plaque that clogs arteries. Ideally, LDL levels should be less than
100 milligrams per deciliter (mg/dL).
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HDL Cholesterol • Sometimes referred to as “good cholesterol.” It does not have

the tendency to clog arteries like LDL cholesterol does and, in
fact, actually helps remove some LDL cholesterol from the body.
To help reduce the risk of heart disease, in conjunction with
lowering LDL levels below 100 mg/dL, HDL levels should typically
be kept around 60 mg/dL.
Type 1 Diabetes • With type 1 diabetes, the pancreas does not make enough
insulin (or none at all), which is a hormone that helps transport
glucose into cells to be used for energy. Without insulin, glucose
in the blood (i.e., blood sugar) can rise to dangerous levels,
causing numerous health complications. Type 1 diabetes is
typically genetic and is not something a person can actively
prevent. However, regular exercise can help people with type 1
diabetes considerably improve their blood glucose management
and quality of life.
Type 2 Diabetes • With type 2 diabetes, the body still produces insulin; however, it
is not used properly by the cells. When excess carbohydrates
(specifically sugar) are chronically consumed in the diet, high
levels of insulin need to be produced to help regulate blood
sugar. When excess insulin continually tries to deliver glucose to
cells when they already have more than they can use, cells stop
responding to it. This state is called insulin resistance. Once cells
have become insulin resistant, a person is said to have
developed type 2 diabetes. Regulating blood sugar can become
very difficult for these individuals, which may lead to
uncontrolled blood sugar levels and a wide variety of health
complications.

Chapter 2. The Personal Training Profession Summary

• From working in a large health club, to training clients in their own homes, fitness
professionals have numerous options to establish a personal training practice with a
consistent flow of clients.
• Another employment choice for fitness professionals is starting a fitness business, which
could include working with clients in their homes, running outdoor group workout
programs, or opening a studio.
• As technology is evolving, there are many options for offering training services online.
• Working as an independent contractor allows a fitness professional to establish his or her
own pay rates and to earn the entire amount, but operational expenses, insurance costs,
and taxes must also be accounted for.
• The first step in succeeding as a CPT is offering uncompromising customer service.
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• Selling personal training services is about asking a client to make a commitment to an

exercise program to improve his or her own health, wellness, and fitness, which makes
selling an activity of uncovering client needs and presenting solutions to those problems.
• If rapport is properly built with a prospective client, sales will feel natural and automatic.
• Forecasting techniques should be used to predict how many clients will need to be serviced
to support a desired annual financial goal.
• Marketing is the process of communicating how a specific product or service will meet the
wants and needs of a potential client.
• The Four Ps of marketing include product, price, promotion, and place.
• Social media and other digital marketing campaigns are extremely important for growing a
modern fitness business.
• Continuing education courses are not just necessary for recertification; they can teach
fitness professionals how to work with niche populations and enable the expansion of a
fitness business to new and exciting areas.
• The most popular methods of earning CEUs are attending workshops or conferences or
completing online education programs. Additionally, CEUs can be earned by participating in
livestream webinars, reading fitness articles and passing a quiz or test, or contributing to
the industry by creating content for fitness education programs, speaking at conferences,
and presenting webinars.
Important Concepts (not an exhaustive list)
SWOT Analysis • Strengths: Identify the strengths and competitive advantages
including education, skills, abilities, or work experience with a
specific population. Examples of strengths might be education,
certifications earned; the name or location of employer, which
itself may have a strong brand identity; or experience working
with a particular type of client. The strengths can ultimately help
identify the professional traits to develop a brand identity.
• Weaknesses: Identify any and all weaknesses; be honest and
thorough, the more honestly a fitness professional can assess
their weakness, the more opportunities for growth can be
identified. Examples of weaknesses might be unfamiliarity with
specific types of clients such as elite athletes, being
uncomfortable with the sales process, or overall lack of fitness
industry experience.
• Opportunities: Identify the opportunities for developing new
professional skills or expanding into new business opportunities,
such as being able to coach group workout programs.
Weaknesses can be turned into opportunities; for example, the
lack of education in a specific area of exercise science is actually
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an opportunity to take a continuing education workshop to gain

the necessary knowledge to work with a specific type of client.
• Threats: Identify all of the threats that might impact a fitness
professional’s business. Examples of threats are the general
economic climate, the number of other fitness professionals
working in a health club, or competitors who plan on growing or
expanding into the marketplace. In some cases, threats are due
to external forces that cannot be controlled (such as an
economic recession), while in other cases they can be turned
into opportunities for new business.
4 Ps of Marketing** very • Communicating the benefits of using a product.
important • Identifying a competitive price of the service.
• Determining how the service will be promoted.
• Selecting the place or method of distribution.
Continuing Education** • A total of 2.0 CEUs is required to renew the NASM-CPT
very important credential every 2 years: 1.9 CEUs from continuing education
efforts and 0.1 CEU from renewing a CPR/AED certification.
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Section 2: Client Relations and Behavioral

Coaching
Chapter 3. The Psychology of Exercise Summary
● Psychology is an important component to behavioral change and plays a key role in
adopting a regular habit to exercise.
● Psychologists and psychiatrists are trained and licensed professionals who treat people with
mental illnesses.
● Sport and exercise psychology is a subtopic of psychology that focuses on understanding
why people participate in sports and exercise, including motives and barriers to
participation.
● Extrinsic motivation happens when someone does something for rewards or recognition.
● Intrinsic motivation describes the motivation to do something that comes from within an
individual; it is strongly related to long-term adherence.
● Motivation to exercise differs among individuals and will change over time; therefore,
motives should be reevaluated over time.
● Common barriers to exercise include lack of time, unrealistic goals, lack of social support,
social physique anxiety, lack of convenience, and ambivalence, but all barriers can be either
eliminated or minimized with some basic strategies that provide realistic solutions or
alternatives.
● Lack of time can be minimized by improving time management and reevaluating daily
priorities.
● Setting unrealistic goals can become a barrier to exercise, therefore, the fitness professional
should assist clients with setting appropriate outcome and process goals.
● Social physique anxiety refers to people feeling anxious about how others perceive their
bodies and can be a barrier to exercise participation. Helping clients find activities that
reduce this type of anxiety will help create a comfortable exercise environment.
● The perception barrier of exercise as inconvenient can be overcome by making the exercise
experience as appealing as possible, both by providing excellent customer service in clean
facilities and by helping clients find ways to exercise outside of a fitness facility.
● Ambivalence to exercise occurs when someone has mixed feelings about exercise and likely
sees pros and cons to participation.
● Social influences on exercise can come from other people, the internet, or the environment;
these influences can lead people both toward and away from exercise.
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● Social support consists of a source (who or what provides it) and a type (instrumental,
emotional, informational, and companionship), and clients will have different needs and
expectations of social support.
● Instrumental support includes the tangible things that assist people with the ability to
exercise, such as providing transportation to a fitness facility, assisting with childcare, or
packing someone’s gym bag.
● Emotional support comes from being caring, empathetic, and concerned about someone’s
experience with exercise.
● Showing empathy includes the ability to relate to the way another person feels or views a
situation.
● Informational support is one of the main reasons why someone will seek out a fitness
professional; it includes providing accurate and current information about fitness and
exercise.
● Companionship support is when someone exercises with another person.
● Group influences on exercise refer to the influence held by other people over whether or
not someone exercises and can come from family members, parents, exercise leaders,
exercise groups, or the surrounding community.
● Parental influence is important for children and adolescents, whereas instrumental support
is often cited as the most influential type of support.
● The exercise leader sets the tone of the class and is responsible for creating an inviting and
inclusive exercise environment.
● Once formed, exercise groups often feel distinct from others and can lead to additional
accountability and encouragement.
● The community influences exercise by the safety level of the exercise environment and the
number of opportunities for exercise, which includes sidewalks, green spaces, playgrounds,
and walking trails.
● Exercise provides several psychological benefits that can enhance overall well-being,
including improved mood, better sleep quality, increased self-esteem, improved body
image, and fewer depression and anxiety symptoms.
Important Concepts (not an exhaustive list)
Examples of extrinsic • Social recognition
motivation for exercise** • Rewards from competitions (trophy or award)
very important • Improvement of physical appearance
Examples of Intrinsic • Stress relief
motivation for exercise** • Increasing energy
very important • Finding new ways to be challenged physically
Examples of outcome • Place in top 10 in a 10K race
goals** very important • Achieving a certain level of body fat
• Achieving a certain level of strength improvement
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Examples of process • Jog for 45 minutes, starting at 6:30 a.m. Monday–Friday to assist
goals** very important with weight loss efforts.
• Eating 1600 calories per day of mostly whole, unprocessed foods to
assist with weight loss efforts.
• Strength training 5 days per week, targeting each muscle group to
increase gains in muscle mass.

Chapter 4. Behavioral Coaching Summary

● Clients expect professionalism, thus, it is crucial to build relationships and maintain a facility
that supports training competency.
● Program designs should be based on the clients’ abilities and should address their health
concerns and goals.
● Self-efficacy is one of the strongest determinants of physical activity in adults; most
coaching efforts are directed at increasing a person’s self-efficacy.
● Planning and self-monitoring are essential techniques in developing a self-regulatory
strategy to improve self-efficacy.
● Affective judgments and subjective norms can impact a person’s readiness to perform
resistance training.
● CPTs should assess a client’s stage of change and promote competency in exercise.
● The stages of change include precontemplation, contemplation, preparation, action, and
maintenance.
● Both verbal and nonverbal forms of communication are important for developing
professional client relationships.
● Active listening refers to having a genuine interest in understanding the client’s health and
fitness goals. It involves asking appropriate questions, avoiding distractions and inner
dialogue, and providing appropriate feedback.
● Motivational interviewing is a style of coaching that is used to enhance intrinsic motivation
for change. CPTs can use some techniques from motivational interviewing, such as
developing a discrepancy between a client’s current state and ideal state, promoting change
talk, and assessing readiness, willingness, and perceived ability to change.
● BCTs are used to enhance the determinants of behavior. CPTs may use any number of
strategies to enhance a client’s confidence, motivation, or self-regulation skills through
planning, self-monitoring, and goal setting.
● Cognitive strategies that can help change behaviors include positive self-talk, imagery, and
the practice of psyching up before activity.
● Goals that clients set should be SMART: specific, measurable, attainable, realistic, and
timely. Clients should also focus on both process goals and outcome goals.
● For the best outcomes, clients should determine long-term bigger goals, then develop a
series of smaller goals that help drive progress to the main goal.
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Important Concepts (not an exhaustive list)

Self-efficacy One’s belief that they can complete a task, goal, or performance; also
known as self-confidence.
Self-monitoring Observing, measuring, and evaluating one’s own behavior, often in the
form of a diary or log.
Stages of Change Model** • Precontemplation: Client does not exercise and is not planning to
very important start exercising within 6 months.
• Contemplation: When a person is thinking about implementing
change but has not yet taken any steps to get started; an individual
may take action within the next 6 months.
• Preparation: The client intends to act in the near future, usually
within the next month.
• Action: The client has made specific modifications in their exercise
routine within the past 6 months.
• Maintenance: The client has been exercising for more than 6
months and is working to prevent relapse.
Decisional balance Reflects the clients’ weighing of the pros and cons of changing.
Examples of closed-ended • Are you motivated to exercise?
questions** very • Can you commit to exercising three days per week?
important • Do you enjoy exercise?
Examples of open-ended • How might you go about making this change?
questions** very • What challenges do you see, and how can you plan to overcome
important them?
• What work are you prepared to do to reach your goal?
• What have you tried in the past to reach your fitness goal?
Examples of SMART • I will gain 5 pounds (2.27 kg) of muscle within 5 months, starting
goals** very important today, by weight lifting a minimum of 4 days per week for 1 hour
each session.
• I will reduce my blood pressure by five points within 6 months by
walking a minimum of 30 minutes each day and reducing my daily
salt intake to no more than 2,300 milligrams per day.
• I will lose 10 pounds (4.53 kg) of body fat within 3 months by
reducing my daily calories from 3,000 to 2,000 per day and
exercising at a moderate intensity at a minimum of 150 minutes per
week.

Examples that are not SMART Goals

• I will lose weight so I can become the best version of myself.
o This goal is not specific or measurable— how much weight?
o This goal does not have a timeframe— how long is this goal?
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• I will gain 10 pounds of muscle, so I’m ready for beach season.

o This goal is not specific— what steps will you perform to gain
muscle?
• I will lose 50 pounds in two months, so I look my best for my
upcoming class reunion.
o This goal is not realistic— losing 50 pounds in two months in a
safe fashion is impossible for most people.
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Section 3: Basic and Applied Sciences and

Nutritional Concepts
Chapter 5. The Nervous, Muscular, and Skeletal Systems Summary
Nervous System
● The human movement system includes an integration of the nervous, skeletal, and
muscular systems.
● The nervous system provides sensory (afferent) and motor (efferent) information.
● The neuron is the functional unit of the nervous system.
● The nervous system includes the CNS (brain and spinal cord) and PNS (somatic and
autonomic nervous system).
● The PNS contains different types of sensory receptors such as mechanoreceptors,
nociceptors, chemoreceptors, and photoreceptors.
● The muscle spindle and Golgi tendon organ are two important sensory receptors
(mechanoreceptors).
● The PNS contains two subdivisions: the somatic and autonomic nervous systems.
● The nervous system requires different electrolytes for proper function, which include
sodium, potassium, magnesium, and water.
● Motor skill development often occurs in three stages: cognitive, associative, and
autonomous.
● The nervous system develops as humans age from childhood to adulthood.

Important Concepts (not an exhaustive list)

Human movement system The collective components and structures that work together to move
(HMS) the body: muscular, skeletal, and nervous systems.
Neuron Specialized cell that is the functional unit of the nervous system.
Three components of a Neurons are composed of three main parts: cell body, axon, and
neuron dendrites.
Central nervous system A division of the nervous system that includes the brain and spinal cord.
(CNS)
Peripheral nervous system Nerves that connect the rest of the body to the central nervous system.
(PNS)
Afferent pathway Sensory pathway that relays information to the central nervous system.
Efferent pathway A motor pathway that relays information from the central nervous
system to the rest of the body.
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Mechanoreceptors Specialized structures that respond to mechanical forces (touch and

pressure) within tissues and then transmit signals through sensory
nerves.
Somatic nervous system Nerves that serve the outer areas of the body and skeletal muscle and
are largely responsible for the voluntary control of movement.
Autonomic nervous A division of the peripheral nervous system that supplies neural input to
system organs that run the involuntary processes of the body (e.g., circulating
blood, digesting food, producing hormones).
Sympathetic nervous Subdivision of the autonomic nervous system that works to increase
system neural activity and put the body in a heightened state.
Parasympathetic nervous Subdivision of the autonomic nervous system that works to decrease
system neural activity and put the body in a more relaxed state.
Proprioception The body’s ability to naturally sense its general orientation and relative
position of its parts.
Muscle spindles** very Sensory receptors sensitive to change in length of the muscle and the
important rate of that change.
Golgi tendon organ (GTO) A specialized sensory receptor located at the point where skeletal
** very important muscle fibers insert into the tendons of skeletal muscle; sensitive to
changes in muscular tension and rate of tension change.
Three stages of motor skill • During stage 1 (cognitive), you may need to use simple instructions
development and break down the skill into smaller steps so your clients will be
able to understand the goals of the movement.
• During stage 2 (associative), you may need to help refine your
clients’ skills through practice and regular feedback.
• During stage 3 (autonomous), you may be able to teach your clients
new versions of the skill to further challenge them.

Skeletal System
● The skeletal system provides support for the body and protects the internal organs.
● The skeletal system has two divisions: axial and appendicular.
● Human bones act as attachment sites and levers (rigid rods) to produce movement
when muscles contract.
● Bone growth occurs throughout life and remodels itself with specialized cells called
osteoblasts and osteoclasts.
● There are five categories of bones: long, short, flat, irregular, and sesamoid.
● The vertebral column has five distinct regions: cervical, thoracic, lumbar, sacrum, and
coccyx.
● In between each vertebra is an intervertebral disc that acts as a shock absorber and
assists with movement.
● Joints are formed by one bone articulating with another and can be categorized by their
shape, structure, and function.
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● Osteokinematic describes bone movement, and arthrokinematic describes movement at

the joint surface.
● Synovial joints are unique with a synovial capsule but also contain other connective
tissues, such as ligaments and fascia that provide support.
● Synovial joints have six classifications: gliding (plane), condyloid, hinge, saddle, pivot,
and ball-and-socket joints.
● Exercise and proper nutrition can have a major positive impact on bone mass with the
aging adult.

Important Concepts (not an exhaustive list)

Skeletal system A description of the bones of the body. In the human skeletal system, there are
206 bones of which approximately 177 are used in voluntary movement.
Axial skeleton A division of the skeletal system consisting of the skull, the rib cage, and the
vertebral column. There are approximately 80 bones in the axial skeleton.
Appendicular A division of the skeletal system consisting of the arms, legs, and pelvic girdle.
skeleton The appendicular skeleton encompasses approximately 126 bones.
Remodeling The process by which bone is constantly renewed by the resorption and
formation of the bone structure.
Osteoclasts Special cells that break down and remove old bone tissue.
Osteoblasts Special cells that form and lay down new bone tissue.
Types of Bones Bone Characteristic Example
Type
Long Long, cylindrical shaft with • Humerus (i.e., the upper arm
irregular or widened ends bone)
• Femur (i.e., the thigh bone)
Short Similar in length and width and • Carpals of the wrist
appear somewhat cubical in • Tarsals of the ankle
shape
Flat Thin, protective surfaces that • Scapulae (i.e., the shoulder
provide broad surfaces for blades)
muscles to attach • Sternum (i.e., the breast plate)
• Ribs

Irregular Unique shape and function from • Vertebrae (i.e., the spinal
all other bone types column)
Sesamoid Small, often round bones • Patella (i.e., the kneecap)
embedded in a joint capsule or
found in locations where a tendon
passes over a joint
Depressions Flattened or indented portions of bone.
Processes Projections protruding from the bone where tendons and ligaments can attach.
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Segments of Segment Description

Vertebral Column Cervical spine • First seven vertebrae starting at the top of the spinal
(C1–C7) column
• Form a flexible framework and provide support and motion
for the head
Thoracic spine • Twelve vertebrae located in the upper and middle back
(T1–T12) behind the ribs
• Each vertebra articulates with a rib helping form the rear
anchor of the rib cage
• Larger than cervical vertebrae and increase in size from top
to bottom
Lumbar spine • Five vertebrae of the low-back below the thoracic spine
(L1–L5) • Largest segments in the spinal column
• Support most of the body’s weight and are attached to
many back muscles
Sacrum • Triangular bone located below the lumbar spine
• Composed of five vertebrae that fuse together as the body
develops into adulthood
Coccyx • Located below the sacrum, more commonly known as the
tailbone
• Composed of three to five small fused bones
Osteokinematics Movement of a limb that is visible.
Arthrokinematics The description of joint surface movement; consists of three major types: roll,
slide, and spin.
Synovial joints A joint with a fluid-filled joint capsule.
Nonaxial A gliding joint that moves in only one plane, either back and forth or side to
side.
Nonsynovial joints Joints that have no joint capsule, fibrous connective tissue, or cartilage in the
uniting structure.

Muscular System
● The muscular system links the nervous and skeletal systems and generates force to
move the human body.
● Muscles have a complex structure that includes different layers of connective tissue that
surround the contractile muscle fibers.
● Myofibrils consist of repeating sarcomeres and the myofilaments actin and myosin,
which create the muscle contraction called the sliding filament theory. Adenosine
triphosphate is also needed to create energy for this process.
● Excitation-contraction coupling describes the steps in the muscle contraction process
involving the nervous and muscular systems.
● The electrolyte calcium and neurotransmitter acetylcholine are involved in the
excitation-contraction coupling process.
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● The all-or-nothing principle describes how a motor unit either maximally contracts or
does not contract at all.
● Muscles involved with fine motor skills have motor units with fewer innervated fibers.
Motor units involved in gross motor control have motor units with more innervated
fibers.
● Type I, slow-twitch, muscle fibers are smaller in size, produce less force, and are fatigue
resistant.
● Type II, fast-twitch, muscle fibers are larger in size, produce more force, and fatigue
quickly.

Important Concepts (not an exhaustive list)

Three types of muscles The three types of muscles in the body are skeletal, cardiac, and smooth.
Skeletal muscle The type of muscle tissue that connects to bones and generates the
forces that create movement.
Fascia Connective tissue that surrounds muscles and bones.
Epimysium Inner layer of fascia that directly surrounds an entire muscle, commonly
referred to as the “deep fascia.”
Fascicles Largest bundles of fibers within a muscle. Fascicles are surrounded by
perimysium.
Perimysium Connective tissue surrounding a muscle fascicle.
Endomysium Connective tissue that wraps around individual muscle fibers within a
fascicle.
Tendons v. Ligaments • Tendons connect muscles to bones. Commonly discussed tendons
include the Achilles tendon at the ankle and the patellar tendon of
the knee. When a tendon is overstretched or torn, this is known as a
strain.
• Ligaments connect bones to bones. A commonly discussed ligament is
the anterior cruciate ligament of the knee that connects the tibia to
the femur. When a ligament is overstretched or torn, it is known as a
sprain.
Myofibrils The contractile components of a muscle cell; the myofilaments (actin and
myosin) are contained within a myofibril.
Myofilaments The filaments of a myofibril; include actin and myosin.
Actin The thin, stringlike, myofilament that acts along with myosin to produce
muscular contraction.
Myosin The thick myofilament that acts along with actin to produce muscular
contraction.
Sarcomere The structural unit of a myofibril composed of actin and myosin filaments
between two Z-lines.
Motor unit A motor neuron and all of the muscle fibers that it innervates.
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Sliding filament theory The series of steps in muscle contraction involving how myosin (thick) and
actin (thin) filaments slide past one another to produce a muscle
contraction, shortening the entire length of the sarcomere.
Type I muscle fibers** Muscle fibers that are small in size, generate lower amounts of force, and
very important are more resistant to fatigue.
Type II muscle fibers** Muscle fibers that are larger in size, generate higher amounts of force,
very important and are faster to fatigue.

Chapter 6. The Cardiorespiratory, Endocrine, and Digestive Systems

Summary
● The cardiorespiratory system is comprised of the heart, blood, blood vessels, and lungs.
● The respiratory system is comprised of the respiratory airways, lungs, and respiratory
muscles.
● The heart is contained in an area referred to as the mediastinum.
● A normal heart rate ranges from 60 to 100 beats per minute.
● Each side of the heart has two chambers: an atrium and a ventricle.
● The body will increase the heart rate in response to exercise and decrease the heart rate
during sleep.
● The electrical conduction system of the heart is responsible for its function and begins
with the sinoatrial node, which is in the right atrium.
● The sinoatrial node is referred to as the pacemaker of the heart and sends the electrical
signal to the atrioventricular node and ultimately into the ventricles.
● The right atrium gathers deoxygenated blood returning to the heart from the body and
then sends it to the right ventricle and to the lungs for oxygenation.
● The left atrium receives oxygenated blood from the lungs and sends it to the left
ventricle to be pumped out into the body.
● Special valves are present in the heart to ensure that blood is pumped in a one-way
fashion.
● The pulmonary artery transports deoxygenated blood from the right ventricles to the
lungs, whereas the pulmonary vein transports oxygenated blood from the lungs to the
left atrium.
● As part of the normal integrated functioning of the cardiorespiratory system, the carbon
dioxide from the deoxygenated blood pumped into the lungs from the right ventricle is
ultimately expelled to the environment through normal expiration.
● Stroke volume is the amount of blood pumped out of the heart with each contraction.
● End-diastolic volume is the volume of blood in the ventricle prior to contraction,
whereas the end-systolic volume is the amount of blood present in the ventricle after
contraction.
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● Stroke volume is ultimately a product of end-systolic volume minus end-diastolic

volume.
● Cardiac output is the volume of blood pumped out of the heart in a minute and is a
function of both heart rate and stroke volume.
● Normal blood pressure is a systolic less than 120 mm Hg with a diastolic of less than 80
mm Hg.
● Arteries transport blood away from the heart to the body, whereas veins transport
blood back to the heart, and capillaries function as an exchange channel between the
vessels and bodily tissues.
● Breathing (ventilation) is divided into two phases, referred to as inspiration and
expiration.
● The respiratory system is tasked with bringing in oxygen, filtering air from inspiration,
and subsequently oxygenating blood from the heart as well as exhaling carbon dioxide.
● A normal respiratory rate is 12 to 16 breaths per minute and relies on the primary
respiratory muscles (diaphragm and intercostals).
● During normal inspiration, active contraction of respiratory muscles occurs, whereas
relaxation occurs during expiration.
● During forced or heavy breathing, expiratory ventilation relies on secondary muscles to
compress the thoracic cavity and force air out.
● Diffusion is a term used to describe the process of getting oxygen from the environment
to the body’s tissues.
● Abnormal breathing patterns will affect exercise performance and may be identified by
shallow breaths, which often are associated with the use of secondary respiratory
muscles (sternocleidomastoid, upper trapezius, or scalenes).
● A respiratory rate of less than 8 breaths per minute would be considered too slow
(bradypnea), whereas a rate of greater than 24 breaths per minute is considered too
high (tachypnea).
● The endocrine system is comprised of glands that secrete hormones.
● When hormones are released into the bloodstream, they are protected by transporters,
which carry them to the intended organ or structure, where they bind with a receptor to
stimulate a particular function.
● The hypothalamus and pituitary gland control a majority of functions for the endocrine
system.
● Cortisol, which is stimulated by the adrenal cortex, may be used to aid in recovery from
exercise and as a marker of overtraining.
● Insulin and glucagon both function to control blood glucose levels and work opposite to
each other; glucagon aids in the metabolism of glucose, and insulin aids in the cellular
uptake and storage of glucose.
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● The catecholamines, which consist of epinephrine and norepinephrine, are immediately

stimulated from the adrenal medulla in response to exercise.
● Cortisol, considered a catabolic hormone, is produced by the adrenal cortex and is
sensitive to blood sugar and sleep.
● Although testosterone levels decline with age, they can be stimulated through intense
exercise.
● Growth hormones are responsible for growth and development as well as lipolysis and
are produced from the pituitary gland.
● One of the most potent of the anabolic hormones is insulin-like growth factor, which is
produced by the liver in response to growth hormones binding on liver receptors.
● Testosterone, growth hormones, and insulin-like growth factors are stimulated in
response to anaerobic resistance training as well as vigorous aerobic activity (e.g., high-
intensity training styles).
● Thyroid hormones serve numerous functions in the body, including metabolism and
increasing bone mineral density through the secretion of calcitonin.
● Adequate sleep is a necessary requirement for glucose metabolism, hormone function,
and muscle recovery.
● The digestive system consists of the oral cavity (head and mouth), the upper GI system
(stomach, small intestine [duodenum, jejunum, and ileum], and the lower GI tract (large
intestine, rectum, and anus), as well as the liver, gall bladder, and pancreas.
● Ingested foods and liquids are first processed in the oral cavity where mastication (the
mechanical process of chewing and breaking down food) begins the digestive process.
● Once food is broken down, it passes through the esophagus into the stomach where
gastric juices aid in digestion, kill bacteria, and turn food into chyme, which is then
passed into the small intestine.
● The small intestine has a key function of absorption of carbohydrates, lipids, calcium,
amino acids, and iron. Additionally, electrolytes including water, are absorbed into the
small intestines.
● The large intestine absorbs electrolytes and vitamins, and serves to pass waste from
nondigested food into the rectum.
● While fluids are absorbed into both the small and large intestine, the large intestine
uses water to help pass waste into the rectum.
● The liver, gall bladder, and pancreas produce and store digestive juices, which are
secreted into the small intestine to help with digestion.
● Evidence suggests that exercise can improve digestive function by increasing transit
time of food from the upper to the lower GI tracts.

Important Concepts (not an exhaustive list)

Cardiovascular System
CPT Exam Study Guide

Atrium (atria) Superior chamber(s) of the heart that gathers blood returning to the heart.
Ventricle Inferior chamber of the heart that pumps blood to the lungs and body.
Blood flow • Right atrium: receives deoxygenated blood returning from the body and sends
through the it to the right ventricle.
heart** very • Right ventricle: receives deoxygenated blood from the right atrium and sends
important it to the lungs.
• Left atrium: receives oxygenated blood from the lungs and sends it to the left
ventricle.
• Left ventricle: receives oxygenated blood from the left atrium and sends it to
the body.
Resting heart Resting heart rates for most of the population are between 60 and 100 beats per
rate minute
Sinoatrial (SA) Located in the right atrium, this node initiates an electrical signal that causes the
node heart to beat.
Atrioventricular Located between the atria and ventricles, this node delays the impulse from the
(AV) node sinoatrial node before allowing it to pass to the ventricles.
Stroke volume The amount of blood pumped out of the heart with each contraction.
End-diastolic The filled volume of the ventricle before contraction.
volume
End-systolic The volume of blood remaining in the ventricle after ejection.
volume
Bradycardia When the heart rate is less than 60 beats per minute.
Tachycardia When the heart rate is greater than 100 beats per minute.
Cardiac The overall performance of the heart (heart rate × stroke volume).
output** very
important
Arteries Vessels that transport blood away from the heart.
Capillaries The smallest blood vessels and the site of exchange of elements between the
blood and the tissues.
Veins Vessels that transport blood back to the heart.
Arterioles Small arteries that eventually divide into capillaries
Venules Small veins that allows blood to drain from capillaries into the larger veins.
Venous pooling The accumulation of blood into the extremities due to slow blood flow though the
veins (venous return) or backflow.
Stages of American Heart Association Criteria (mm Hg)
hypertension** Blood Pressure Classification
very important Normal Systolic <120 and diastolic <80
Elevated Systolic 120–129 and diastolic <80
Stage 1 Systolic 130–139 or diastolic 80–89
Stage 2 Systolic ≥140 or diastolic ≥90
Hypertensive crisis Systolic >180 and/or diastolic >120
Respiratory System
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Structures of Bones Sternum (breastbone)

respiratory Ribs
pump Vertebrae (spine)
Inspiration Muscles Diaphragm
External intercostals (muscles between individual ribs)
Scalenes (side of neck muscles)
Sternocleidomastoid (front of neck muscle)
Pectoralis minor (smaller chest muscle)
Expiration Muscles Internal intercostals (muscles between individual ribs)
Abdominals
Valsalva A process that involves expiring against a closed windpipe, creating additional
maneuver intra-abdominal pressure and spinal stability.
Structures of Conducting Airways Nasal cavity
respiratory Oral cavity
passages Pharynx
Larynx
Trachea
Right and left pulmonary bronchi
Bronchioles
Respiratory Airways Alveoli
Alveolar sacs
Tachypnea Respiratory rate that is too fast; greater than 24 breaths per minute.
Bradypnea Respiratory rate that is too slow; fewer than 8 breaths per minute.
Dyspnea Shortness of breath or labored breathing.
Endorcine System
Lipolysis The breakdown and utilization of fat for energy.
Insulin A hormone secreted by the pancreas that is responsible for glucose metabolism.
Glucagon A hormone secreted by the pancreas that regulates blood glucose and functions
opposite to insulin.
Glycogen Glucose that is deposited and stored in bodily tissues, such as the liver and muscle
cells; the storage form of carbohydrate.
Growth An anabolic hormone produced by the pituitary gland that is responsible for
hormone growth and development.
Catecholamines Hormones produced by the adrenal glands that are part of the stress response
known as the fight-or-flight response.
Catabolic Metabolic process that breaks down molecules into smaller units used for energy.
Gluconeogenesis The formation of glucose from noncarbohydrate sources (proteins and fats).
Testosterone A hormone producing secondary male sex characteristics.
Anabolic Metabolic process that synthesizes smaller molecules into larger units used for
building and repairing tissues.
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Insulin-like Anabolic hormone produced by the liver, which is responsible for growth and
growth factors development.
(IGF)
Calcitonin Thyroid hormone that helps the body use calcium properly to aid with maintaining
bone mineral density.
Glucose A condition that results in elevated blood glucose levels.
intolerance

Chapter 7. Human Movement Science Summary

● Movement is described in three dimensions that are based on planes, which include the
sagittal, frontal, and transverse planes.
● Osteokinematic describes the observable movement of a limb, whereas arthrokinematic
describes the movement taking place at the joint itself.
● Movement is described using biomechanical terminology that is universal to all
professions in the allied health industry.
● The sagittal plane is an imaginary line that bisects the body into right and left sides.
Movements in the sagittal plane include flexion and extension and plantar flexion and
dorsiflexion of the foot and ankle.
● The frontal plane bisects the body to create front and back halves. Movements in the
frontal plane include abduction and adduction of the limbs (relative to the trunk), lateral
flexion of the spine, and eversion and inversion at the foot and ankle complex.
● The transverse plane bisects the body to create upper and lower halves. Movements in
the transverse plane include internal rotation and external rotation for the limbs, right
and left rotation for the head and trunk, horizontal abduction and horizontal adduction
of the limbs, and radioulnar pronation and supination.
● Motions of the scapulae include scapular retraction, scapular protraction, scapular
depression, and scapular elevation.
● Muscle actions are described as isotonic, isometric, and isokinetic.
● Isotonic muscle actions can be broken down into the concentric and eccentric phases.
● Muscles can play the role of agonist, synergist, stabilizer, or antagonist depending on
the movement being performed.
● Closed-chain movements anchor the body to the ground or immovable object, whereas
open-chain movement involves the distal limb moving freely in space.
● Placing a muscle in a shortened position or lengthening a muscle beyond optimal length
may reduce force output, because optimal length is the position with maximal overlap
of actin and myosin filaments.
● The stretch-shortening cycle involves three phases, which include the eccentric phase,
amortization phase, and concentric phase.
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● The term force-couple is used to describe muscles that work in a synergistic function
around a joint.
● The local muscular system involves muscles that generally attach on or near the spine
and provide stability for the LPHC.
● The global muscle system can be broken down into subsystems, which include the deep
longitudinal, posterior oblique, anterior oblique, and lateral subsystems.
● The subsystems describe the integrated function of muscle groups to transfer force for
complex multijoint movements and stabilization of the HMS.
● The amount of force produced by the HMS relies on not only muscle recruitment but
also the lever type of the joint that is moving.
● Lever systems are classified as first, second, and third class. Third-class levers are the
most predominate levers in the human body.
● Muscle synergies describe the cooperative function of multiple muscles recruited by the
nervous system to complete a given movement pattern.
● Proprioception is the intrinsic awareness of movement and bodily position in space.
● Feedback can come from internal or external sources and aids the process of motor
learning.
● Motor learning is the integration of motor control processes, with practice and
experience, leading to a relatively permanent change in the capacity to produce skilled
movements.
Important Concepts (not an exhaustive list)
Anatomic Anatomic Definition
locations** Location
very
Medial Relatively closer to the midline of the body
important
Lateral Relatively farther away from the midline or
toward the outside of the body
Contralateral Positioned on the opposite side of the body
Ipsilateral Positioned on the same side of the body
Anterior Positioned on or toward the front of the
body
Posterior Positioned on or toward the back of the
body
Proximal Positioned nearest to the center of the body
or other identified reference point

Distal Positioned farthest from the center of the

body or other identified reference point
Inferior Positioned below an identified reference
point
Superior Positioned above an identified reference point
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Dorsiflexion Flexion occurring at the ankle (i.e., top of the foot moves toward the shin).
Plantar Extension occurring at the ankle. Pointing the foot downwards.
flexion
Muscle Action Performance
actions** Isotonic Force is produced, muscle tension is developed, and movement
very occurs through a given range of motion. Isotonic muscle actions are
important subdivided into concentric and eccentric muscle actions.
Isometric Muscle tension is created without a change in muscle length and no
visible movement of the joint.
Isokinetic The speed of movement is fixed, and resistance varies with the force
exerted.

It requires sophisticated training equipment often seen in

rehabilitation or exercise physiology laboratories.
Agonists** The primary muscles providing force for a movement. Examples include:
very • The gluteus maximus is the agonist for hip extension (i.e., squats).
important • The anterior deltoid is the agonist for shoulder flexion (i.e., shoulder presses).
• The biceps brachii is the agonist for elbow flexion (i.e., biceps curls).
• The triceps brachii is the agonist for elbow extension(i.e., triceps pushdowns).
Synergists** Muscles that assist agonists to produce a movement. Examples include:
very • The hamstring complex and the erector spinae are synergistic with the gluteus
important maximus during hip extension (i.e., squats).
• The brachioradialis and brachialis (forearm muscles) assist the biceps brachii
during a biceps curl.
• The triceps brachii assist the pectoral muscles during a chest press.
• The biceps brachii assist the latissimus dorsi during a pull-up.
Stabilizers** Muscles that contract isometrically to stabilize the trunk and joints as the body
very moves. Examples include:
important • The transversus abdominis (a deep abdominal muscle), internal obliques, and
multifidus (deep muscles of the spine) stabilize the LPHC during hip extension
(i.e., squats).
• The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and
subscapularis), stabilize the shoulder during upper extremity movements.
Antagonists** Muscles on the opposite side of a joint that are in direct opposition of agonist
very muscles. Examples include:
important • The biceps brachii (an elbow flexor) is an antagonist to the triceps brachii during
elbow extension (i.e., triceps pushdown).
• During elbow flexion, the triceps become the antagonist to the biceps (i.e.,
biceps curl).
• The hip flexor complex is antagonistic to the gluteus maximus during hip
extension (i.e., squats).
• The latissimus dorsi is antagonistic to the deltoids during a shoulder press.
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Example • Push-ups
closed-chain • Pull-ups
exercises** • Squats
very • Lunges
important
Example • Biceps curls
open-chain • Lat pulldowns
exercises** • Bench presses
very • Leg curls
important • Leg extensions
Length- The resting length of a muscle and the tension the muscle can produce at this resting
tension length.
relationship*
* very
important
Altered When a muscle’s resting length is too short or too long, reducing the amount of force
length- it can produce.
tension
relationship*
* very
important
Reciprocal When an agonist receives a signal to contract, its functional antagonist also receives
inhibition** an inhibitory signal allowing it to lengthen.
very
important
Altered Occurs when an overactive agonist muscle decreases the neural drive to its
reciprocal functional antagonist.
inhibition**
very
important
Muscle When muscles on each side of a joint have altered length-tension relationships.
imbalance
Integrated To move with efficiency, forces must be dampened (eccentrically), stabilized
performance (isometrically), and then accelerated (concentrically).
paradigm
Force-couple The synergistic action of multiple muscles working together to produce movement
relationship* around a joint
* very
important
First-class First-class levers have the fulcrum in the middle, like a seesaw. Nodding the head is
levers an example of a first-class lever, with the top of the spinal column as the fulcrum.
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Second-class Second-class levers have a resistance in the middle with the fulcrum and effort on
levers either side, similar to a load in a wheelbarrow where the axle and wheel are the
fulcrum points. The body acts as a second-class lever when one engages in a full-
body push-up or calf raise.
Third-class Third-class levers have the effort placed between the resistance and the fulcrum. The
levers effort always travels a shorter distance and must be greater than the resistance.
Most limbs of the human body operate as third-class levers. An example of a third-
class lever is the human forearm; the fulcrum is the elbow, the effort is applied by
the biceps brachii muscle, and the load is in the hand, such as a dumbbell when
performing a biceps curl. Another example of a third-class lever is the standing
hamstring curl, whereby the knee joint is the fulcrum, hamstring muscle is the effort,
and resistance is at the ankle.
Motor Motor response to internal and external environmental stimuli.
behavior
Motor control How the central nervous system integrates internal and external sensory information
with previous experiences to produce a motor response.
Motor Integration of motor control processes through practice and experience, leading to a
learning relatively permanent change in the capacity to produce skilled motor behavior.
Motor Change in skilled motor behavior over time throughout the life span.
development
Internal Process whereby sensory information is used by the body to reactively monitor
feedback movement and the environment.
External Information provided by some external source, such as a fitness professional, video,
feedback mirror, or heart rate monitor, to supplement the internal environment.

Chapter 8. Exercise Metabolism and Bioenergetics Summary

● The human body needs a constant supply of energy to function properly and meet the
demands of exercise.
● The energy molecule used to do cellular work is called adenosine triphosphate (ATP),
and it is made from food substrates consumed in the diet.
● The first law of thermodynamics states that energy can neither be created nor
destroyed, only converted from one form into another.
● The fuels used to create ATP are glucose from carbohydrates, free fatty acids from fat,
amino acids from protein, and ketone bodies. These fuels are mostly obtained through
the diet.
● Carbohydrates in the diet are broken down into glucose, which can produce ATP quickly
via the process of glycolysis.
● Glucose is stored in the form of glycogen; the amount of glycogen that can be stored in
the body is much less than the amount of fat that can be stored.
● Free fatty acids are the by-products of the breakdown of stored or consumed fats. They
are oxidized exclusively via the aerobic pathway, which uses oxygen to create ATP.
● Amino acids are the by-product of protein breakdown or digestion.
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● Amino acids can be metabolized via oxidative phosphorylation, but this is not typical in
healthy people because protein is usually reserved for muscle building rather than ATP
production.
● Ketone bodies are produced by the liver during periods of low energy intake or low
carbohydrate availability. They can be oxidized via the oxidative phosphorylation
pathway to create ATP.
● Exercise is categorized by two factors: intensity and duration. The higher the intensity of
the activity, the shorter the duration must be.
● To perform exercise, the body needs fuel, which comes from food that is broken down
through a series of chemical reactions to provide energy (ATP) and heat.
● The ATP-PC pathway is the simplest and fastest way to generate ATP. This system can
only support short duration activities because the supply of PC is limited.
● Glycolysis is an anaerobic process and generates ATP quickly, but not a tremendous
amount. The end products of glycolysis are ATP and pyruvate, which can become lactate
under anaerobic conditions.
● Oxidative phosphorylation is a process that uses oxygen to create ATP from substrate
molecules at a relatively slow rate.
● Oxidative phosphorylation can use pyruvate (starting from glucose), fatty acids, amino
acids, or ketone bodies as substrate molecules. This oxidative metabolism produces
carbon dioxide as a by-product, which is then exhaled.
● The most important factors determining the type of energy use during exercise are
intensity and duration.
● The intensity and duration of an activity are inversely related, which means that as
intensity goes up, duration must go down.
● Steady-state exercise is defined as a situation in which a person engages in the same
level of activity, without increases or decreases in intensity, for several minutes.
● Intermittent exercise is defined as frequent changes in the work requirement (intensity)
during an activity.
● Exercise increases metabolic rate, and breathing rate increases in proportion with it.
● When breathing rate becomes too rapid to allow talking, the body has shifted to
oxidizing almost exclusively carbohydrate to fuel the activity.
● Lower-intensity activities use a higher percentage of fat as a fuel but generally do not
burn a lot of calories unless performed for a very long time.
● Higher-intensity activities have a higher percentage of energy coming from
carbohydrate and usually burn more total calories in a given time.
● Daily food (energy) intake needs to be adequate to maintain a healthy body weight,
allow for proper bodily function, and support physical activity.
● If daily food intake is matched to energy needs, a person is said to be in energy balance.
CPT Exam Study Guide

● Calories are the basic unit of energy provided by food, and the total number of calories
that a person burns in a day is called the total daily energy expenditure (TDEE).
● The resting metabolic rate (RMR) is the minimum number of calories needed at rest to
keep a person alive and meet all functional needs of the body.
● The thermic effect of food (TEF) is the number of calories that are used to digest a meal.
● Nonexercise activity thermogenesis (NEAT) involves burning calories in activities that are
not structured exercise.
● Exercise activity thermogenesis (EAT) is the calories burned during structured physical
activity or purposeful exercise.
Important Concepts (not an exhaustive list)
First law of Energy cannot be created or destroyed but merely converted from one form
thermodynamics to another.
Glucose The simplest form of carbohydrate used by the body for energy.
Glycogen Glucose that is deposited and stored in bodily tissues, such as the liver and
muscle cells; the storage form of carbohydrate.
Triglyceride The chemical or substrate form in which most fat exists in food as well as in
the body.
Essential amino acid Amino acid that must be obtained through the diet as the body does not
(EAA) make it; there are nine essential amino acids.
Nonessential amino Amino acids that can be synthesized by the body and do not, under normal
acids circumstances, need to be obtained in the diet.
Gluconeogenesis The formation of glucose from noncarbohydrate sources (proteins and fats).
Aerobic Processes relating to, involving, or requiring oxygen.
Anaerobic Processes relating to the absence of oxygen.
ATP-PC system** very An energy system that provides energy very rapidly, for approximately 10–15
important seconds, via anaerobic metabolism.
• Example exercises that predominately use the ATP-PC system include:
o Short sprints
o Olympic weightlifting
o Jumping and plyometrics
Glycolytic system** A metabolic process that occurs in the cytosol of a cell that converts glucose
very important into pyruvate and adenosine triphosphate. Anaerobic glycolysis refers to
when this process occurs in the absence of oxygen. It lasts longer, with a
capacity of approximately 30 to 60 seconds of duration.
• Example exercises that predominately use the glycolytic system include:
o Strength training (8-12 repetitions)
Oxidative system** The most complex of the three energy systems is the oxidative system—a
very important process that uses oxygen to convert food substrates into ATP. This process is
called oxidative phosphorylation, and it is defined as an aerobic process
because it needs oxygen to complete the reactions.
• Example exercises that predominately use the oxidative system include:
o Jogging and running for an extended period
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Electron transport A series of protein complexes that transfer protons and electrons received
chain (ETC) from the citric acid cycle through a series of reactions to create adenosine
triphosphate.
Excess postexercise The state in which the body’s metabolism is elevated after exercise.
oxygen consumption
(EPOC)
Resting metabolic The rate at which the body expends energy (calories) when fasted and at
rate (RMR) complete rest, such as asleep or lying quietly.
Exercise activity The calories expended through structured exercise or training.
thermogenesis (EAT)
Thermic effect of food The energy required to digest, absorb, and process nutrients that are
(TEF) consumed.
Nonexercise activity Energy expenditure through daily activities outside of structured exercise,
thermogenesis (NEAT) such as walking, completing household chores, and taking the stairs.

Chapter 9. Nutrition Summary

• Registered and licensed dietitians and nutritionists are authorized to provide nutrition
counseling, medical nutrition therapy, and meal plans.
• Fitness professionals (who are not also registered or licensed dietitians or nutritionists)
can provide general nutrition guidelines, direct clients to credible nutrition resources,
refer clients to dietitians and nutritionists, and provide accountability and support with
dietary changes.
• Credible and reliable nutrition information includes peer-reviewed research and
scholarly sources.
• Protein is comprised of 20 amino acids; 9 are essential and must be obtained via the
diet.
• The role of protein is the synthesis of tissues, organs, hormones, enzymes, and peptides.
• Dietary sources of complete proteins include soy and animal foods, such as meat,
poultry, seafood, and dairy. Plant-based, incomplete protein foods include legumes,
grains, and vegetables.
• Protein contains 4 calories per gram.
• The RDA for protein is 0.8 g/kg bodyweight (considered a minimum to maintain nitrogen
balance).
• The AMDR for protein is 10% to 35% of total calories.
• Carbohydrates include simple sugars, complex carbohydrates, glycogen, and fiber.
• Carbohydrates are an important energy source of exercising individuals and athletes.
• Dietary sources of carbohydrates include plant foods and dairy, including grains,
vegetables, legumes, fruit, milk, and yogurt.
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• Simple sugars include the monosaccharides (glucose, fructose, galactose) and

disaccharides (lactose, sucrose, maltose).
• Complex carbohydrates are long chains of glucose units called polysaccharides, which
are slower to digest and raise blood glucose levels slowly.
• Sources of complex carbohydrates include starches, legumes, and vegetables.
• The glycemic index reflects the effect of a carbohydrate on blood sugar levels; low GI
foods cause smaller rises in blood glucose compared to high GI foods.
• Glycemic load is a better indicator of a carbohydrate’s effect on blood sugar levels,
because it accounts for the glycemic index and the quantity of carbohydrates consumed.
• Carbohydrates contain 4 calories per gram.
• Glycogen is the storage form of carbohydrates in animals and humans. Glycogen is
stored in the liver and skeletal muscle.
• Fiber is indigestible carbohydrates associated with various health benefits and includes
both soluble and insoluble fiber.
• The AMDR for carbohydrate is 45% to 65% of calories in the diet.
• Fiber recommendations: 25–28 g of fiber a day for women (aged 19–50 years) and 30–
34 g of fiber a day for men aged 19–50 years.
• Lipids are commonly referred to as fats and include triglycerides, phospholipids, and
sterols.
• Saturated fat sources include animal fats, full-fat dairy, coconut, and palm oil.
• Polyunsaturated fat sources include omega-6 (nuts, seeds, oils), omega-3 (fatty fish,
flaxseed, walnuts, chia seeds, fortified milk/eggs, dairy from grass-fed cows, and green
vegetables).
• Monounsaturated fat sources include olives, olive oil, avocado, peanuts, and canola.
• Phospholipid sources include meats, egg yolks, seafood, poultry, soybeans, and grains.
• Sterols sources include cholesterol from animal foods, egg yolks, and plant sterols.
• Lipids contain 9 calories per gram.
• The AMDR for lipids is 20% to 35% of total calories.
• Vitamins and minerals are inorganic compounds essential to regulating metabolic
processes, such as energy metabolism. Deficiencies and insufficiencies can contribute to
health issues.
• Vitamins include two groups: fat soluble and water soluble.
• Vitamins A, D, E, and K are fat soluble.
• Water-soluble vitamins include vitamin C and B vitamins (thiamin, riboflavin, niacin,
folate, B12, pantothenic acid, biotin).
• A balanced diet with a wide variety of minimally processed foods will likely supply
adequate vitamins.
• Minerals include major minerals and trace minerals.
CPT Exam Study Guide

• Fluid recommendations (general population): approximately 11.5 cups a day (2.7 L) of

fluid for women and approximately 15.5 cups (3.7 L) for men.
• Hydration guidelines for athletes include 12–16 oz of fluid every 10–15 minutes for
activities longer than 60 minutes.
• Athletes should replace fluid at 1.25 times the amount of body weight lost during an
event.
• Sports drinks may be hypotonic (lower concentration than body fluids), isotonic (similar
concentration as body fluids), or hypertonic (higher concentration than body fluids).
• Sports drinks are likely unnecessary for short-duration exercise lasting less than 60
minutes (unless in hot or humid temperatures).
• Strategy combinations are used to help clients achieve their weight goals, primarily
including modification of energy intake and physical activity.
• The first law of thermodynamics states that energy cannot be created or destroyed but
only converted from one form to another.
• Weight gain is the result of energy intake exceeding energy output, whereas weight loss
is the result of energy output exceeding energy intake.
• Other factors that influence weight include sleep, medications, and endocrine disorders.
• Food labels convey information on the nutritional value and content of products via the
nutrition facts panel and the ingredients list.
• Food labels can help clients make informed decisions about how a food item contributes
to their nutrition and fitness goals.
• Fat loss requires a net calorie deficit but with the goal of minimizing loss of lean body
mass and any reduction in TDEE due to adaptive thermogenesis.
• Adequate caloric intake, especially adequate protein intake combined with resistance
training, remains an essential element for increasing muscle mass.
• Nutrition strategies for improved sports performance are numerous and include
ensuring adequate energy (calories) and macronutrient intake. Meal timing and
hydration are also important to maximize sport performance.

Important Concepts (not an exhaustive list)

Macronutrients • Protein: 4 calories per gram
and alcohol • Carbohydrate: 4 calories per gram
energy** very • Lipid (fat): 9 calories per gram
important • Alcohol: 7 calories per gram
Amino acids Essential Nonessential Conditionally Essential
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• Leucine • Alanine • Histidine

• Isoleucine • Arginine • Arginine
• Valine • Aspartic acid • Glutamine
• Methionine • Asparagine
• Phenylalanine • Cysteine
• Threonine • Glutamic acid
• Tryptophan • Glutamine
• Lysine • Glycine
• Histidine* • Proline
• Serine

Complete protein A protein source that provides all essential amino acids.
Incomplete A protein that lacks one or more of the amino acids required to build cells.
protein
RDA for protein 0.8 g/kg of body weight
Acceptable • Protein: 10% to 35% of total calories
macronutrient • Carbohydrate: 45% to 65% of total calories
distribution • Lipid (fat): 20% to 35% of total calories
ranges (AMDR) **
very important
Triglycerides The triglyceride family is composed of fats and oils; it comprises 98% of the
stored lipids in the body and approximately 95% of the lipids in foods.
Fat-soluble A, D, E, K
vitamins** very
important
Water-soluble C, B-vitamins
vitamins** very
important
Fluid intake • Women: 11.5 cups per day (2.7 L)
• Men: 15.5 cups per day (3.7 L)

Chapter 10. Supplementation Summary

● Dietary supplements are products (other than tobacco) intended to supplement the diet
that bears or contains one or more of the following dietary ingredients: vitamins;
minerals; herbs or other botanicals; amino acids; dietary supplements used by humans
to supplement the diet by increasing the total dietary intake; or concentrates,
metabolites, constituents, extracts, or combination of any previously described
ingredient.
● In the United States, dietary supplements are regulated by the FDA according to the
Dietary Supplement Health and Education Act. However, supplements do not require
review or approval prior to being marketed and sold.
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● The fitness professional should understand the required components of the dietary
supplement label, including the active ingredients, other ingredients, pertinent
warnings, total contents, usage instructions, and serving size.
● Dietary supplements may be used for health and/or performance goals.
● Dietary supplements used specifically for performance are classified as ergogenic aids.
● Vitamin and mineral supplements may be used by individuals to correct or supply
insufficient dietary intake in an effort to consume the DV each day.
● Vitamin and mineral intake should not exceed the UL unless by the direction of a
dietitian or physician.
● Dietary supplements and other ergogenic aids may produce adverse effects or serious
adverse effects. Such effects may arise from the dietary supplements themselves or
from a change to or the contamination of the products.
● Protein supplements are convenient methods to increase total daily protein intake, the
most important consideration for protein intake. Protein needs depend on the activity
level, body size, and body composition goal of the individual.
● An effective dose of creatine is at least 0.03 g per kg body weight, but a typical dose at 5
g per day ensures complete muscle saturation.
● An effective dose of caffeine is 3 to 6 mg/kg (1.4–2.7 mg/lb) per day.
● Banned substances may not always be illegal substances, and athletes must check with
their governing body (such as the NCAA or WADA) prior to consuming a dietary
supplement. It is also wise for athletes to choose a supplement with third-party
verification from Informed Choice or NSF.
● It is beyond the scope of practice for a fitness professional to prescribe dietary
supplements to clients to treat a medical condition or disease. It is appropriate for the
fitness professional to provide general education about supplements or to direct a client
to consult with a dietitian or medical professional.
Important Concepts (not an exhaustive list)
Dietary A product (other than tobacco) intended to supplement the diet that bears or
supplement contains one or more of the following dietary ingredients: vitamin; mineral; herb or
other botanical; amino acid; substance used by man to supplement the diet by
increasing the total dietary intake; or concentrate, metabolite, constituent, extract,
or combination of any previously described ingredient.
Dietary The primary legislation of the U.S. government regulating dietary supplements.
Supplement
Health and
Education Act
of 1994
Tolerable The greatest quantity of a vitamin or mineral that may be consumed in a day
upper limit without risk of an adverse health effect.
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Ergogenic aid A dietary supplement that may enhance performance or body composition; it may
also be referred to as a performance supplement.
Adverse effects Men Women
of anabolic Acne Development of masculine features
steroids Loss of head hair Increased body and facial hair
Gynecomastia (development of breasts) Deepening of voice
Irritability and aggression Irritability and aggression
Altered sex drive (increased or Altered sex drive (increased or
decreased) decreased)
Sleeplessness Fluid retention

Testicular atrophy Menstruation irregularities

Decreased sperm count Breast atrophy
Worsened cholesterol profiles Clitoral enlargement
Prostate enlargement Acne
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Section 4: Assessment
Chapter 11. Health, Wellness, and Fitness Assessments Summary
● The general purposes of conducting physiological assessments are to collect baseline
data to help fitness professionals develop personalized exercise programs.
● The PAR-Q+ is considered an appropriate minimal screening tool for conducting a HRA.
● Fitness professionals should also gather additional information, through the use of a
HHQ, that may prove useful in selecting fitness assessments, designing exercise
programs, and monitoring progress.
● A HHQ includes information about a client’s medical history (e.g., injuries, surgeries,
medications, and chronic disease) and lifestyle habits (e.g., exercise, diet, sleep, stress,
and occupation).
● Resting and exercising heart rate and blood pressure responses provide valuable
information pertaining to health risks and training adaptations.
● There are many anatomical locations that can be used to measure a client’s RHR.
However, for accuracy, safety, and ease of administering, NASM recommends that
fitness professionals measure a client’s radial pulse.
● Blood pressure (BP) is defined as the outward pressure exerted by blood on the arterial
walls. BP scores are important because higher scores indicate greater risks for
developing cardiovascular disease, which can become life-threatening. A normal BP
reading is less than 120/80 mm Hg.
● Anthropometry is the field of study of the measurement of living humans for purposes
of understanding physical variation in size, weight, and proportion.
● Many different anthropometric measures exist, including body fat assessments, BMI,
and circumference measurements. Anthropometric measurements provide useful
information related to predicting a client’s risk for mortality and morbidity.
● There are many methods for measuring a client’s body fat percentage, including
underwater weighing, skinfold measurements, and bioelectrical impedance analysis.
While all methods are valid, for ease of use, bioelectrical impedance is arguably the
most popular method used in fitness facilities.
● Cardiorespiratory assessments help the fitness professional identify safe and effective
starting exercise intensities as well as appropriate modes of cardiorespiratory exercise
for clients. Examples of cardiorespiratory assessments include V O2max testing, the
YMCA 3-minute step test, the Rockport walk test, and the 1.5 mile run test.
● V O2max testing is considered the gold standard for identifying a client’s level of
cardiorespiratory fitness, but it requires specialized equipment and training to conduct.
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In addition, it requires the client to exert maximal effort. Consequently, this test is not
commonly used outside of exercise laboratories or medical facilities.
● The talk test is an informal cardiorespiratory assessment used to gauge the intensity of
cardiorespiratory activity based on the client’s ability to hold a conversation.
● The VT1 test is an incremental test performed on any device (e.g., treadmill, bike) that
gradually progresses in intensity level and relies on the interpretation of how a person
talks to determine a specific event at which the body’s metabolism undergoes a
significant change. A key point to this protocol is to remember that it is an aerobic test
that aims to estimate the intensity where the body is using a balance of fuels (i.e., 50%
fat, 50% carbohydrates).
● The VT2 talk test measures the intensity where the body can work at its highest
sustainable steady-state intensity for more than a few minutes.

Important Concepts (not an exhaustive list)

Contraindication A specific situation where a medication, procedure, or exercise should
be avoided because it may prove to be harmful to the individual.
Physical Activity Readiness A detailed questionnaire designed to assess an individual’s physical
Questionnaire (PAR-Q+) readiness to engage in structured exercise.
Health history A questionnaire with lists of questions that pertain to health history and
questionnaire (HHQ) habits, such as exercise history, eating behaviors, and general lifestyle
Manual heart rate For accuracy, safety, and ease of administration, NASM recommends
measurement that fitness professionals measure a client’s radial pulse.
Blood pressure ranges • Normal (healthy): Less than 120/80 mm Hg
• Elevated: Systolic between 120 and 129 and diastolic less than 80
mm Hg
• Stage 1 hypertension: Systolic between 130 and 139 or diastolic
between 80 and 89 mm Hg
• Stage 2 hypertension: Systolic 140 or higher or diastolic 90 mm Hg or
higher
• Hypertensive crisis: Systolic greater than 180 and/or diastolic greater
than 120 mm Hg
Body mass index (BMI) The measurement of a person’s weight relative to his or her height,
which is used to estimate the risks of obesity.
• Metric formula: BMI = weight (kg) ÷ [height (m)]2
• Imperial formula: BMI = 703 × weight (lb) ÷ [height (in.)]2
Bioelectrical impedance A body composition assessment technique that estimates body fat
analysis (BIA) percentage by measuring the resistance to the flow of electrical currents
introduced into the body.
BMI Classification BMI Disease Risk Classification
<18.5 Increased Underweight
18.5–24.9 Low Healthy weight
25.0–29.9 Increased Overweight
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30.0–34.9 High Obese

35.0–39.9 Very high Obesity II
≥40.0 Extremely high Obesity III
Waist-to-hip ratio (WHR) The relative score expressing the ratio of the waist circumference to the
hip circumference, which correlates to the risk for developing
cardiovascular disease.
• WHR = Waist Measurement ÷ Hip Measurement
WHR Classifications Health Risk Men Women
Low 0.95 or lower 0.80 or lower
Moderate 0.96–1.0 0.81–0.85
High 1.0 or higher 0.86 or higher
Jackson and Pollock • Men: Chest, mid-axillary, subscapular, triceps, abdomen, suprailiac,
Seven-Site Measurement thigh
• Women: Chest, mid-axillary, subscapular, triceps, abdomen,
suprailiac, thigh
Jackson and Pollock • Men: Chest, abdomen, thigh
Three-Site Measurement • Women: Triceps, suprailiac, thigh
Durnin–Womersley Four- • Men & Women: Biceps, triceps, subscapular, and suprailiac
Site Measurement**very
important

Chapter 12. Posture, Movement, and Performance Assessments

Summary
● Static posture is typically assessed in standing position and is used to identify the three
postural distortions: pes planus distortion syndrome, upper crossed syndrome, and
lower crossed syndrome.
● Pes planus distortion syndrome is characterized by flat feet, knee valgus, and internally
rotated and adducted hips.
● Lower crossed syndrome is characterized by an anterior pelvic tilt and excessive lordosis
of the lumbar spine.
● Upper crossed syndrome is characterized by a forward head and protracted shoulders.
● The OHSA is the first movement assessment performed for clients and serves as the
basis for all other movement assessments. It evaluates dynamic posture, core stability,
and neuromuscular control of the whole body during a squatting motion.
● During the OHSA, notate all movement impairments to identify potential muscle
imbalances. From the anterior view, look for feet turning out or knees caving in. From
the lateral view, look for low-back arching, excessive forward lean of the torso, or arms
falling forward.
● The single-leg squat assessment should be used by clients who have performed well in
the OHSA, or if the fitness professional is considering single-leg exercises in their
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programming. This test is a good assessment of an individual’s ability to balance, which

is an important functional consideration for activities of daily living and exercise
programming.
● Pushing and pulling assessments evaluate function of the upper extremity and
concurrent core stability. They can be used as an intake assessment or an integrated
part of the actual programming.
● When performing pushing or pulling assessments, look for the following movement
impairments: low-back arching, shoulders elevating, or head jutting forward.
● Performance assessments can be used for clients looking to improve athletic
performance, and measure maximal strength, power, muscular endurance, and speed
and agility.
● The push-up test measures muscular endurance of the upper extremities during a
pushing movement.
● The bench press and squat strength assessments measure maximal strength capabilities.
These tests are advanced assessments for strength-specific goals and may not be
suitable for clients with limited experience with resistance training.
● The vertical jump and long jump assessments measure lower-body power.
● The LEFT test is designed to test lateral speed and agility. LEFT is considered an
advanced assessment for speed and performance-specific goals.
● The 40-yard dash assessment evaluates reaction capabilities, acceleration, and maximal
sprinting speed.
● The pro shuttle (5-10-5) test assesses acceleration, deceleration, agility, and control.
This test is most appropriate for clients with athletic goals seeking to assess agility and
sprinting speed.
● All assessments need to be sequenced in a specific order to help guarantee accurate
results. Nonfatiguing assessments, such as a preparticipation health screening and
physiological and body composition assessments, should be conducted prior to posture,
movement, cardio, and performance assessments.
● Fitness professionals should always use caution when implementing movement and
performance assessments with their clients. Certain populations, such as overweight or
obese, youths, older adults, and prenatal clients, may need to modify or avoid certain
movement and performance assessments. Some assessments are not applicable
because they do not relate to the client’s goals. Other assessments may cause safety
concerns.
Important Concepts (not an exhaustive list)
Pes planus distortion Static Positions
syndrome** very Ankle joints—pes planus (collapsed arch)
important Knee joints—valgus and internally rotated
Hip joints—adducted and internally rotated
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Potential overactive muscles

• Gastrocnemius and soleus (calves)
• Adductor complex (inner thighs)
• Hip flexors (muscles near front of hips)

Potential underactive muscles

• Anterior and posterior tibialis (shin muscles)
• Gluteus maximus and medius (butt muscles)
Lower crossed Static Positions
syndrome** very Hip joints—flexed
important Pelvis—anterior pelvic tilt
Lumbar spine—excessive lordosis (extension)

Potential overactive muscles

• Hip flexors
• Lumbar extensors (low-back muscles)

Potential underactive muscles

• Gluteus maximus and medius
• Hamstring complex
• Abdominals
Upper crossed Static Positions
syndrome** very Thoracic spine—excessive kyphosis (hunchback, flexed posture)
important Shoulders—protracted (rounded forward) and internally rotated
Head and neck—jutted forward

Potential overactive muscles

• Pectoralis major and minor (chest muscles)
• Levator scapula and sternocleidomastoid (neck muscles)
• Upper trapezius

Potential underactive muscles

• Middle and lower trapezius, rhomboids (mid-back muscles)
• Deep cervical flexors (muscle deep within the neck)
Overhead Squat Assessment
Feet turn out** very Overactive
important • Gastrocnemius/soleus (calves)
• Hamstrings complex
Underactive
• Anterior and posterior tibialis (shin muscles)
• Gluteus maximus and medius
Knees cave in (knee Overactive
valgus) ** very important • Tensor fascia latae (TFL)(muscle near front of hip)
• Adductor complex (inner thigh muscles)
Underactive
• Gluteus maximus and medius
• Anterior and posterior tibialis
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Low-back arches** very Overactive

important • Hip flexors (rectus femoris, psoas, TFL)
• Lumbar extensors (low-back muscles)
• Latissimus dorsi (large back muscle)
Underactive
• Gluteus maximus
• Hamstrings complex
• Abdominals
Excessive forward trunk Overactive
lean** very important • Hip flexors
• Gastrocnemius/soleus
• Rectus abdominis and external obliques (superficial abdominal
muscles)
Underactive
• Gluteus maximus
• Hamstrings complex
• Lumbar extensors
Arms fall forward** very Overactive
important • Latissimus dorsi
• Pectoralis major and minor (chest muscles)
• Teres major (posterior shoulder muscle)
Underactive
• Middle and lower trapezius (mid-back muscle)
• Rhomboids (muscles near shoulder blades)
• Posterior deltoids (back of shoulder muscles)
• Portions of the rotator cuff (small muscles that stabilize the
shoulder)
Single-leg Squat Assessment
Knee caves in (knee Overactive
valgus) ** very important • Tensor fascia latae (TFL)
• Adductor complex
Underactive
• Gluteus maximus and medius
• Anterior and posterior tibialis
Pushing Assessment
Low-back arches** very Overactive
important • Hip flexors (rectus femoris, psoas, TFL)
• Lumbar extensors
Underactive
• Gluteus maximus
• Hamstrings complex
• Abdominals
Scapular elevation** very Overactive
important • Levator scapulae (posterior neck muscles)
• Upper trapezius
Underactive
• Lower trapezius
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Head juts forward** very Overactive

important • Levator scapulae
• Sternocleidomastoid (anterior neck muscles)
Underactive
• Deep cervical flexors (deep neck stabilizer muscles)
Pulling Assessment
Low-back arches** very Overactive
important • Hip flexors (rectus femoris, psoas, TFL)
• Lumbar extensors
Underactive
• Gluteus maximus
• Hamstrings complex
• Abdominals
Scapular elevation** very Overactive
important • Levator scapula
• Upper trapezius
Underactive
• Lower trapezius

Head juts forward** very Overactive

important • Levator scapulae
• Sternocleidomastoid
Underactive
• Deep cervical flexors
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Section 5: Exercise Technique and Training

Instruction
Chapter 13. Integrated Training and the OPT Model Summary
● Integrated training combines flexibility, cardiorespiratory, core, balance, plyometric,
SAQ, and resistance training into one system.
● When an exercise program is progressive and systematic, using a progressive overload
approach, the body becomes stronger by adapting to the new demands placed on it.
● Fundamental movement patterns include squatting, hip hinge, pulling, pushing, and
pressing.
● Maintaining ideal posture places the client’s body in the most optimal state to perform
movement patterns safely and effectively.
● Optimal ROM allows joints to move freely.
● Fitness professionals should provide programming that requires movement in all three
planes of motion: sagittal, frontal, and transverse.
● The acute variables for training include repetitions, sets, training intensity, repetition
tempo, rest interval, training volume, training frequency, training duration, exercise
selection, and exercise order.
● An ever-changing integrated training approach provides a systematic and progressive
approach to fitness training; its components include flexibility, cardiorespiratory, core,
balance, plyometric (reactive), SAQ, and resistance training.
● Benefits of flexibility training include increased joint ROM, possible decrease in muscle
soreness, and a potential reduction in injury risk.
● Benefits of cardiorespiratory training include decreased heart rate and blood pressure
while increasing stroke volume and cardiac output.
● Benefits of core training include enhanced posture; better bodily function for daily
living; increased balance, stabilization and coordination of the kinetic chain; minimized
low-back pain; and improved skill-related movements.
● Benefits of balance training include reducing risk of falls and ankle sprains while
improving proprioception and agility-based activities.
● Benefits of plyometric (reactive) training include improved bone mineral density and
soft tissue strength, expression of power and explosiveness, while also increasing
metabolic expenditures required for weight management.
● Benefits of SAQ training include improved top speed, change in direction, and rate of
acceleration and deceleration.
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● Benefits of resistance training include increased endurance, strength, and power;

muscular hypertrophy; and weight management.
● The OPT model is based on the scientific rationale of human movement science and
uses the principles of integrated training.
● The OPT model is divided into three different levels of training: stabilization, strength,
and power, which are subdivided into five phases.
● Phase 1 Stabilization Endurance Training is designed to teach optimal movement
patterns (e.g., pushing, pulling, pressing, squatting, hip hinging), core and joint stability,
and helps clients become familiar with various modes of exercise.
● The goal of Phase 2 Strength Endurance Training is to enhance stabilization endurance
while increasing prime mover strength.
● Phase 3 Muscular Development Training is designed for individuals who have the goal of
maximal muscle growth or altered body composition (i.e., fat loss).
● Phase 4 Maximal Strength Training works toward the goal of maximal prime mover
strength by lifting heavy loads.
● The goal of phase 5 Power Training is to increase maximal strength and rate of force
production.
Important Concepts (not an exhaustive list)
OPT model The stabilization level has one phase of training:
• Phase 1 Stabilization Endurance Training
The strength level has three phases of training:
• Phase 2 Strength Endurance Training
• Phase 3 Muscular Development Training
• Phase 4 Maximum Strength Training
The power level has one phase of training:
• Phase 5 Power Training
Phase 2 Body Part Strength-Focused Exercise Stabilization-Focused
example Exercise
supersets Chest Bench press Push-up
Back Seated cable row Standing cable row
Shoulders Shoulder press machine Single-leg dumbbell
overhead press
Legs Barbell squat Single-leg squat
Phase 5 Body Part Strength-Focused Exercise Power-Focused Exercise
example Chest Bench press Medicine ball chest pass
supersets Back Lat pulldown Medicine ball soccer throw
Shoulders Dumbbell shoulder press Front medicine ball oblique
throw
Leg Barbell squat Squat jump
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Chapter 14. Flexibility Training Concepts Summary

● Flexibility is defined as the normal extensibility of all soft tissues that allows the
complete ROM of a joint.
● Flexibility has a major influence on mobility during dynamic motion.
● Poor flexibility can lead to the development of relative flexibility, which is the process in
which the HMS seeks the path of least resistance during functional movements.
● The HMS, also known as the kinetic chain, comprises the muscular, skeletal, and nervous
systems. The body’s kinetic chain can be further classified into two regional chains:
upper kinetic chain and lower kinetic chain.
● Muscle imbalance can be caused by postural distortions, repetitive movement,
cumulative trauma, emotional duress, poor training technique, poor bodily control, and
biased training patterns.
● Muscle imbalance may result in altered reciprocal inhibition, synergistic dominance, and
osteo- and arthrokinematics dysfunction.
● Synergistic dominance is a neuromuscular phenomenon that occurs when synergists
take over function for a weak or inhibited prime mover (agonist). This leads to altered
reciprocal inhibition of the antagonist muscle.
● Osteokinematics describes how the bones and joints are moving through a ROM, and
arthrokinematics describes the motion at the joint surfaces. Altered joint motion can be
caused by altered muscle length-tension relationships, force-couple relationships, and
poor joint surface motion, which results in poor movement efficiency.
● Neuromuscular efficiency is the ability of the nervous system to recruit the correct
muscles, produce force, reduce force, and dynamically stabilize the body’s structure in
all three planes of motion. To allow for optimal neuromuscular efficiency, individuals
must have proper flexibility in all three planes of motion.
● The scientific rationale for flexibility training is illustrated through the concept of pattern
overload and the cumulative injury cycle.
● Common types of flexibility exercise include self-myofascial techniques and static,
active, and dynamic stretching.
● Self-myofascial rolling is thought to produce both local mechanical and
neurophysiological effects on the myofascial tissues.
● Static stretching is the process of passively taking a muscle to the point of tension and
holding the stretch for a minimum of 30 seconds.
● Active stretching is the process of using agonists and synergists to dynamically move the
joint into a ROM, holding for 1 to 2 seconds and repeating for 5 to 10 repetitions.
● Dynamic stretching uses the force production of a muscle and the body’s momentum to
take a joint through the full available ROM.
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● Fitness professionals should have a comprehensive understanding of controversial

stretches, medical precautions, and contraindications to program a safe flexibility
program for clients of all fitness levels.
Important Concepts (not an exhaustive list)
Relative flexibility The process in which the body seeks the path of least resistance during
functional movements.
A prime example of relative flexibility is seen in people who squat with
their feet excessively externally rotated because individuals may have
limited ankle ROM that prevents adequate ankle dorsiflexion to perform
a squat with proper mechanics. A second example can be seen when
people perform an overhead shoulder press with excessive lumbar
extension (arched low-back).
Force-couple The synergistic action of multiple muscles working together to produce
relationships**very movement around a joint.
important
Reciprocal When an agonist receives a signal to contract, its functional antagonist
inhibition**very also receives an inhibitory signal allowing it to lengthen.
important
Altered reciprocal Occurs when an overactive agonist muscle decreases the neural drive to
inhibition**very its functional antagonist.
important
Synergistic The neuromuscular phenomenon that occurs when synergists take over
dominance**very function for a weak or inhibited prime mover (agonist).
important
Altered length-tension When a muscle’s resting length is too short or too long, reducing the
relationship**very amount of force it can produce.
important
Muscle spindle**very Sensory receptors sensitive to change in length of the muscle and the
important rate of that change.
Golgi tendon organ A specialized sensory receptor located at the point where skeletal
(GTO**very important) muscle fibers insert into the tendons of skeletal muscle; sensitive to
changes in muscular tension and rate of tension change.
Autogenic The process by which neural impulses that sense tension are greater
inhibition**very than the impulses that cause muscles to contract, providing an inhibitory
important effect to the muscle spindles.
Pattern overload Consistently repeating the same pattern of motion over long periods of
time that can lead to dysfunction or injury.
Davis’s law States that soft tissue models along the line of stress.
Self-myofascial rolling Mechanism of Action: Autogenic inhibition
Training Variables: 1-3 sets, hold each tender area for 30 seconds
Static stretching Mechanism of Action: Stretch tolerance and/or reciprocal inhibition
(depending how stretch is performed)
Training Variables: 1-3 sets, hold each stretch for 30 seconds
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Active stretching Mechanism of Action: Reciprocal inhibition

(formerly called active- Training Variables: 1-3 sets, hold each stretch for 1-2 seconds and repeat
isolated stretching) for 5–10 repetitions
Hip flexor, adductor, and Posteriorly rotate the pelvis to increase the effectiveness of the stretch.
latissimus dorsi static and
active stretches**very
important
Dynamic stretching Mechanism of Action: Reciprocal inhibition
Training Variables: 1-3 sets, 5–10 repetitions, 3-10 exercises

Chapter 15. Cardiorespiratory Fitness Training Summary

• Cardiorespiratory fitness reflects the ability of the cardiovascular and respiratory
systems to supply oxygen-rich blood to skeletal muscles during sustained physical
activity.
• Cardiorespiratory fitness is one of five components to health-related physical fitness;
the others include muscular strength, muscular endurance, flexibility, and body
composition.
• Research has confirmed that an individual’s cardiorespiratory fitness level is a strong
predictor of morbidity and mortality.
• Research demonstrates that cardiorespiratory exercise and physical activity provide
many benefits that enhance health, longevity, and weight loss.
• Cardiorespiratory exercise must be individually determined and should use the FITTE-VP
principle. FITTE-VP stands for frequency, intensity, type, time, enjoyment, volume, and
progression.
• Frequency refers to the number of training sessions in a given time period, usually
expressed as per week.
• Moderate-intensity exercise (e.g., brisk walking) should be performed at least five times
per week, whereas vigorous-intensity exercise (e.g., jogging or running) should be
performed at least three times per week, or a combination of moderate-intensity and
vigorous-intensity is also acceptable.
• Intensity refers to the level of demand that a given activity places on the body.
• Some methods for monitoring cardiorespiratory exercise intensity include calculating V
O2 max, using percentages of maximal heart rate (HRmax), heart rate reserve (HRR),
metabolic equivalents (METs), ratings of perceived exertion (RPE), and using the talk
test.
• Time refers to the length of time engaged in an activity or exercise training session and
is typically expressed in minutes.
• Adults should accumulate 2 hours and 30 minutes (150 minutes) of moderate-intensity
aerobic activity (i.e., brisk walking) every week or 1 hour and 15 minutes (75 minutes) of
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vigorous-intensity aerobic activity (i.e., jogging or running) every week, or an equivalent

mix of moderate- and vigorous-intensity aerobic activity.
• Type refers to the mode of activity selected, such as cycling, running, or swimming.
• Enjoyment refers to the amount of pleasure derived from engaging in a specific exercise
or activity.
• Volume of exercise represents the total amount of work performed in each timeframe,
typically 1 week.
• Progression refers to how an exercise program advances.
• Each exercise training session should also include a warm-up phase, conditioning phase,
and cool-down phase.
• Stage 1 is designed to help improve cardiorespiratory fitness levels in apparently healthy
sedentary clients using a target intensity below ventilatory threshold 1 (VT1) and
involves steady-state aerobic exercise.
• A stage 2 workout consists of a mix of recovery intervals just below VT1 (moderate
intensity) and work intervals performed at an intensity just above VT1 (challenging to
hard intensity).
• Once clients become accustomed to stage 2 intervals and have shown positive signs of
adapting to the physical demands, they can begin performing moderately intense
steady-state cardio exercise just above VT1, if desired.
• A stage 3 workout includes the client moving in and out of training zones 1, 2, and 3.
• A stage 4 workout involves interval training integrating all four training zones.
• Stage 5 focuses on drills that help improve conditioning using linear, multidirectional,
and sport-specific activities performed as conditioning and often combines high-
intensity interval training with small-sided games and agility drills.
• Common postural deviations that clients may exhibit while engaging in cardiorespiratory
training include round shoulders and forward head, an anterior pelvic tilt, or adducted
and internally rotated knees and pronated feet.
• Caution should be made to monitor a client’s posture during cardiorespiratory exercise.
Important Concepts (not an exhaustive list)
Aerobic activity Frequency Time Type
recommendations At least 5 days 150 minutes per Moderate-intensity aerobic activity (i.e.,
per week week brisk walking)
At least 3 days 75 minutes per Vigorous-intensity aerobic activity (i.e.,
per week week jogging or running)
3–5 days per Combination of moderate and vigorous intensity: Any
week combination of moderate- and vigorous-intensity aerobic
activities
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Training zones Training Metabolic Description

Zone Marker

Zone 1 Below VT1 • Light to moderate

• Starting to sweat but can still carry on a
conversation effortlessly
Zone 2 VT1 to • Challenging to hard
Midpoint • Noticeable sweating and using larger volumes
of breath
• Continual talking is becoming challenging
Zone 3 Midpoint to • Vigorous to very hard
VT2 • Profuse sweating
• Vigorous breathing and ability to talk is limited
to short phrases
Zone 4 Above VT2 • Very hard to maximum effort
• Breathing as hard as possible
• Speaking is impossible or limited to grunts of
single words
Clients with an Initial use of bicycles or steppers may not be warranted, or should be
anterior pelvic tilt minimized, because the hips are placed in a constant state of flexion, adding to
what may already be an overactive hip flexor complex for many clients. If they
are used, emphasize flexibility techniques for the hip flexors before and after
use. Additional strengthening exercises for the core and gluteal complex are
also recommended.
Clients with • Cardiorespiratory exercise that involves the lower extremities requires
adducted and proper mobility at the ankle joint. Emphasize self-myofascial techniques
internally rotated and stretching for the calves, adductors, and hip flexors. Additional
knees and strengthening exercises for the gluteus medius and maximus are also
pronated feet recommended.
• Using the treadmill and steppers that require climbing may initially be too
extreme for constant repetition if clients are allowed to hold onto the rails
and speed up the pace. If these modalities are used, emphasize the
flexibility exercises mentioned previously and keep the pace at a
controllable speed until these postures are corrected.

Chapter 16 Core Training Concepts Summary

• Core training is critical for improving posture, enhancing performance, increasing injury
resistance, and accelerating injury rehabilitation.
• The core is defined by the structures that make up the lumbo-pelvic-hip complex (LPHC)
and includes the global and local core musculature.
• Local core muscles generally attach on or near the vertebrae. Local muscles provide
dynamic control of the spinal segments, limiting excessive compression, shear, and
rotational forces between spinal segments.
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• Global core muscles are more superficial on the trunk. Global muscles act to move the
trunk, transfer loads between the upper and lower extremities, and provide stability of
the spine by stabilizing multiple segments together as functional units.
• When designing a core training program, the local and global muscles should both be
trained to develop proper core stability and overall movement efficiency.
• Core strength is imperative for maintaining the natural curvatures of the spine, both at
rest and during movement.
• Large curvatures of the spine away from midline are considered abnormal and may be
considered either structural or functional scoliosis.
• Core training has been demonstrated to improve injury resistance by contributing to
more coordinated motion between the trunk and lower extremities during high-energy,
sport-specific activities.
• When developing a core training program, emphasize increasing proprioceptive demand
initially instead of increasing the external resistance. Additionally, emphasize quality of
movement across the LPHC.
• There are many variables that can be manipulated when designing a core training
program, including planes of motion, ranges of motion, speed of motion, volume, and
exercise modalities. Be cautious not to change too many variables at one time when
progressing an exercise program to ensure that the client is able to demonstrate
appropriate mastery at each stage.
• Initially, start with core exercises that involve little motion of the spine and target the
local core musculature. Example exercises include (but are not limited to) marching,
floor/ball bridge, floor/ball cobra, plank, side plank, dead bug, and Palloff press.
• The next-level core exercise progression incorporates more motion at the spine that
also targets global core muscles. Example exercises include (but are not limited to)
floor/ball crunch, back extension, reverse crunch, knee-up, and cable rotation, lift, and
chop.
• The last core exercise progression involves explosive movement through the trunk and
extremities. Example exercises include (but are not limited to) medicine ball chest pass,
ball medicine ball pullover throw, front medicine ball oblique throw, side medicine ball
oblique throw, medicine ball soccer throw, medicine ball woodchop throw, and
medicine ball overhead throw.
Important Concepts (not an exhaustive list)
Examples of local muscles Rotatores, Multifidus, Transverse abdominis, Diaphragm, Pelvic floor
musculature, Quadratus lumborum
Examples of global Rectus abdominis, External abdominal obliques, Internal abdominal
muscles obliques, Erector spinae, Latissimus dorsi, Iliopsoas (iliacus + psoas)
Drawing-in maneuver A maneuver used to recruit the local core stabilizers by drawing in the
navel toward the spine.
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Bracing Contracting the global abdominals such as the rectus abdominis and
obliques at the same time.
Core training variables Planes of motion Volume
• Sagittal • Sets
• Frontal o Low
• Transverse o Moderate
o High
• Repetitions
o Low
o Moderate
o High
Range of motion Progression
• Full • Little or no motion of spine
• Partial • Controlled spinal flexion, extension, rotation
• End range • Explosive trunk movements
Speed of motion Resistance
• Slow • Body weight
• Medium • Light
• Fast • Medium
• Explosive • Heavy
Exercise equipment
• Tubing
• Cables
• Medicine balls
• Free weights
• Balance equipment (e.g., foam pad, wobble
board, balance disc)
Core training progression When initiating a core training program, exercises should initially focus
1 on stabilization through the spine and pelvis without gross movement of
the trunk. These exercises are designed to improve neuromuscular
efficiency and intervertebral stability, focusing on drawing-in and then
bracing during the exercises. These exercises primarily target the local
core muscles. Sample exercises include:
Marching, Floor bridge, Ball bridge, Floor cobra, Ball cobra, Fire hydrant,
Plank, Side plank, Dead bug, Bird dog, Pallof press, and Farmer’s carry
Core training progression The next progression is to involve more dynamic eccentric and
2 concentric movements of the spine throughout a full range of motion. In
other words, these exercises involve flexion, extension, and rotation of
the trunk. In this progression, specificity, speed, and neural demands are
also increased using moderate to fast repetition tempos. Sample
exercises include:
Floor crunch, Ball crunch, Back extension, Reverse crunch. Knee-up.
Cable rotation, Cable lift, and Cable chop
Core training progression The last progression includes exercises that are designed to improve the
3 rate of force production (power) and movement efficiency of the core
musculature and extremities. Example exercises include:
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Medicine ball rotation chest pass, Ball medicine ball pullover throw,
Front medicine ball oblique throw, Side medicine ball oblique throw,
Medicine ball soccer throw, Medicine ball woodchop throw, and
Medicine ball overhead throw
Cable rotation, Cable lift Make sure to pivot the back leg into triple extension:
exercises** very • Hip extension
important • Knee extension
• Ankle plantarflexion (extension)
Cable chop The cable chop is an opposite motion of the cable lift exercise. This time
the back leg will be in flexion rather than extension.

Chapter 17 Balance Training Concepts Summary

• Balance training is a critical component of an exercise program to optimize
performance, improve injury resistance, and enhance injury rehabilitation.
• Maintaining balance involves the ability of an individual to control the position of the
center of gravity over the base of support.
• Types of balance include static (stationary body position), semi-dynamic (the base
supporting the body is in movement), and dynamic (ever-changing base of support) and
can be manipulated to change the level of difficulty during a balance training program.
• The balance mechanism involves three key senses:
o Vision, which is typically used to provide information to the central nervous
system about the body’s location in space
o The vestibular senses, which are controlled by sensory receptors in the inner ear
and provide the brain information about spatial orientation and the movement
of the head in space
o Somatosensation, which is the ability to feel changes in pressure on the skin,
muscle length, and joint angles
• Balance training has been shown to improve performance and reduce injury rates in
athletes when incorporated into a comprehensive injury prevention program that is
carried throughout the course of an athletic season.
• Strong evidence demonstrates that balance training programs can reduce the risk of
falls in healthy older adults.
• Fitness professionals should always emphasize safety when designing a progressive
balance training program, especially for clients with a history of injuries or a current
injury.
• When developing a balance training program, emphasize a safe and progressive
increase in proprioceptive demand based on the client’s performance.
• Many variables can be manipulated when designing a balance training program,
including planes, range, and speed of motion, as well as the proprioceptive
environment. Be cautious not to change too many variables at one time when
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progressing an exercise program to ensure that the client is able to demonstrate

appropriate mastery at each stage.
Important Concepts (not an exhaustive list)
Limits of stability The area within which an individual can move one’s center of gravity without changing the
base of support (i.e., moving the feet) without falling.
Proprioceptively An unstable (yet controllable) exercise environment that causes the body to use its internal
enriched balance and stabilization mechanisms.
environment
Balance training Exercise Selection Variables
parameters • Safe • Plane of motion
• Progressive o Sagittal
• Easy to hard o Frontal
• Simple to complex o Transverse
• Stable to unstable • Lower-body progressions**very
• Static to dynamic important
• Slow to fast o Two-legs/stable (e.g., standing on
• Eyes open to eyes closed the floor)
• Known to unknown (cognitive task) o Wide stance → Narrow stance →
• Single task to dual task Tandem stance (heel-to-toe)
• Balance equipment examples o Single-leg/stable (e.g., standing
o Floor one-legged on the floor)
o Balance beam o Two-legs/unstable (e.g., standing
o Half-foam roll two-legged on a balance modality)
o Foam pad o Single-leg/unstable (e.g., standing
o Balance disc one-legged on a balance modality)
o Wobble board • Perturbation
o Mild to moderate (e.g., gentle
push in one direction → gentle
push in multiple directions)
Balance training When introducing balance exercises into an exercise program, the exercises should initially
progression 1 involve little joint motion of the balance leg. These entry-level balance exercises are
designed to improve reflexive (automatic) muscle contractions to increase joint stability.
Sample exercises include:
Tandem stance, Single-leg balance, Single-leg balance reach, Single-leg hip internal and
external rotation, Single-leg lift and chop, Single-leg arm and leg motion, Single-leg windmill
and Single-leg throw and catch
Balance training The next progression involves dynamic eccentric and concentric movement of the balance
progression 2 leg through a full range of motion. The speed and neural demands of each exercise are
progressed. Sample exercises include:
Single-leg squat, Single-leg squat touchdown, Single-leg Romanian deadlift, Multiplanar
step-up to balance, and Multiplanar lunge to balance
Balance training The last progression includes exercises that are designed to develop proper deceleration
progression 3 ability to move the body from a dynamic state to a controlled stationary position. In other
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words, these exercises combine hopping motions with a single-leg stance landing (holding
the landing position for 3–5 seconds). Example exercises include:
Multiplanar hop with stabilization, Multiplanar single-leg box hop-up with stabilization, and
Multiplanar single-leg box hop-down with stabilization

Chapter 18 Plyometric (Reactive) Training Concepts Summary

• Plyometric training, also known as jump or reactive training, is a form of exercise that
uses explosive movements, such as bounding, jumping, or powerful upper body
movements, to develop muscular power.
• Employing plyometric training develops efficient control and production of ground
reaction forces, which can be used to project the body with a greater velocity or speed
of movement.
• Clients must possess adequate core strength, joint stability, and range of motion and
must balance efficiently prior to performing explosive plyometric exercises.
• The integrated performance paradigm states that to move with precision, forces must
be loaded (eccentrically), stabilized (isometrically), and then unloaded or accelerated
(concentrically).
• The three distinct phases of the stretch-shortening cycle involved in a plyometric
exercise include the eccentric or loading phase, the amortization phase or transition
phase, and the concentric or unloading phase.
• Plyometric exercises increase rate of force production (power) and motor unit
recruitment.
• Plyometric exercises should progress from simple to intermediate to advanced
movements and from low intensity to moderate intensity to high intensity.
• Intensity should be prescribed by the client’s ability to execute the movement and
maintain adequate training technique. If technique is lost, the intensity should drop
until proper technique is achieved.
• Plyometric intensity describes the amount of effort or stress applied by the muscles,
connective tissue, and joints during plyometric drills and by the distance covered (height
of a jump).
• Plyometric volume is expressed as the number of foot contacts, throws, or catches. An
example would be the completion of three sets of five squat jumps, equating to a
volume of 15.
• A general recommendation is to allow at least 1 day between intense plyometric
training sessions. At least 48 to 72 hours between sessions are the recommended
guidelines when implementing plyometrics for novice individuals.
• Since plyometric training involves jumping, bounding, and other explosive movements,
it is essential to teach proper landing and rebounding mechanics.
• As a general rule, recovery times of 60 to 120 seconds between drills should be
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sufficient for full recovery, but this is dictated by the client’s fitness level.
• When introducing plyometric exercises—especially to new or beginner clients—the
movements should initially involve small jumps, and clients should hold the landing
position for 3–5 seconds and make any adjustments necessary to correct faulty postures
before performing the next jump.
• The next progression is to involve jumps with more amplitude and dynamic motion
performed with a repetitive tempo.
• The last progression includes exercises that are performed as fast and as explosively as
possible.
Important Concepts (not an exhaustive list)
Stretch-shortening cycle Loading of a muscle eccentrically to prepare it for a rapid concentric
contraction.
Integrated performance To move with efficiency, forces must be dampened (eccentrically),
paradigm stabilized (isometrically), and then accelerated (concentrically).
Components of the Phase Physiological Event Action
stretch-shortening cycle Eccentric Stored elastic energy; Stretch of agonist
stimulation of muscle muscle
spindles, signal sent
to spinal cord
Amortization Nerves meet synapse Time between the
in spinal cord, signal eccentric and
sent to stretched concentric phases
muscle
Concentric Elastic energy Shortening of agonist
release, enhanced muscle
muscle force
production
Plyometric training Planes of motion Volume
variables 1. Sagittal • Sets
2. Frontal • Low
3. Transverse • Moderate
• High
• Repetitions
• Low
• Moderate
• High
Speed of motion Safety
1. Slow • Performed with supportive shoes
2. Medium • Performed on a proper training
3. Fast surface
4. Explosive • Grass field
• Basketball court
• Tartan track surface
• Rubber track surface
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• Performed with proper

supervision
Progressive Recovery
1. Easy to hard • Allow at least 24 hours
2. Low to high amplitude between plyometric training
3. Simple to complex sessions
4. Known to unknown o 48–72 hours for new
5. Body weight to loaded or deconditioned
6. Activity specific clients
Plyometric training When introducing plyometric exercises, especially to new or beginner
progression 1 clients, the movements should initially involve small jumps (lower
amplitude) to best learn the movement pattern. When an individual
lands during these exercises, they should hold the landing position (or
stabilize) for 3–5 seconds. During this time, individuals should make any
adjustments necessary to correct faulty postures before performing the
next jump. Example exercises include:
Squat jump with stabilization, Box jump-up with stabilization, Box jump-
down with stabilization, and Multiplanar jump with stabilization
Plyometric training The next progression involves jumps with more amplitude and dynamic
progression 2 motion. The speed of the jumps is also progressed. These exercises are
performed in a repetitive fashion, spending a relatively short amount of
time on the ground before repeating the drill. In other words, the client
will no longer hold the landing position for 3–5 seconds but instead
initiate another jump upon landing using a moderate (repeating) tempo.
Some example exercises include:
Squat jump, Tuck jump, Butt kick, and Power step-up
Plyometric training The last progression includes exercises that involve explosive, powerful
progression 3 movements. These exercises are performed as fast and as explosively as
possible. Some example exercises include:
Ice skaters (also known as skater jumps), Single-leg power step-up,
Proprioceptive plyometrics, and Depth jump

Chapter 19 Speed, Agility, and Quickness Training Concepts Summary

● SAQ training is a useful and effective method of fitness training stimulating muscular,
neurological, connective tissue, and even cardiovascular fitness adaptations.
● SAQ exercises can promote improvements in physical performance and sustain youthful
movement throughout life.
● SAQ training will allow clients to enhance their ability to accelerate, decelerate, and
dynamically stabilize their entire body during high-velocity movements in all planes of
motion.
● Speed, the product of stride rate and stride length, refers to the velocity of distance
covered divided by time.
● Agility necessitates the ability to start (or accelerate), stop (or decelerate and stabilize),
and change direction while maintaining postural control.
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● Quickness refers to the ability to react to a stimulus and appropriately change the
motion of the body in response to that stimulus.
● Stride rate is the number of strides taken in a given amount of time (or distance).
● Stride length is the distance covered in one stride.
● Proper running mechanics will enable the client to maximize force generation through
biomechanical efficiency.
● Components of an SAQ program can significantly improve the physical health profile of
apparently healthy, sedentary, nonathletic adults and those with medical or health
limitations.
● SAQ programs for youth have been found to decrease the likelihood of athletic injury,
increase the likelihood of exercise participation later in life, and improve physical
fitness.
● SAQ training for older adults may help prevent age-related decreases in bone density,
coordinative ability, and muscular power.
● The high-intensity, short bouts of SAQ drills make them a valid choice for interval
training protocols with appropriate nonathletic populations, including weight-loss
clients.
Important Concepts (not an exhaustive list)
Speed The ability to move the body in one intended direction as fast as
possible.
Agility The ability to start (or accelerate), stop (or decelerate and stabilize), and
change direction in response to a signal or stimulus quickly while
maintaining postural control.
Examples of agility include:
• Rapidly changing running direction to avoid a tackler in American
football
• Performing a crossover in basketball to attack the basket
• Rapidly changing running direction in an obstacle course
Quickness The ability to react and change body position with maximal rate of force
production, in all planes of motion and from all body positions, during
dynamic activities.
Examples of quickness include:
• Hitting a baseball
• Returning a tennis serve
• Swerving to avoid a car accident
Stride rate The number of strides taken in a given amount of time (or distance).
Stride length The distance covered with each stride during the gait cycle.
Frontside mechanics Proper alignment of the lead leg and pelvis during sprinting, which
includes ankle dorsiflexion, knee flexion, hip flexion, and a neutral pelvis.
Backside mechanics Proper alignment of the rear leg and pelvis during sprinting, which
includes ankle plantarflexion, knee extension, hip extension, and a
neutral pelvis.
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Chapter 20 Resistance Training Concepts Summary

• The GAS model outlines three stages of response to stress: alarm reaction, resistance
development, and exhaustion.
• The alarm reaction stage, the initial reaction to a stressor, can include fatigue, joint
stiffness, or delayed onset muscle soreness.
• The resistance development stage involves numerous physiological changes that
ultimately lead to training adaptations that promote increases in performance.
• Prolonged or intolerable amounts of stress lead to the exhaustion stage, which is
characterized by stress fractures, muscle strains and ligament sprains, joint pain, and
emotional fatigue.
• The principle of specificity, often referred to as the SAID principle, describes the body’s
responses and adaptations to exercise.
• Mechanical specificity refers to the weight and movements placed on the body.
• Neuromuscular specificity refers to the speed of contraction and exercise selection.
• Metabolic specificity refers to the energy demand placed on the body.
• The main adaptations that occur from resistance training include stabilization, muscular
endurance, hypertrophy, strength, and power.
• Stabilization is the body’s ability to provide optimal dynamic joint support to maintain
correct posture during all movements.
• Muscular endurance is the ability to produce and maintain force production for
prolonged periods of time.
• Muscular hypertrophy is the enlargement of skeletal muscle fibers.
• Strength is the ability of the neuromuscular system to produce internal tension,
specifically in the muscles and connective tissues that pull on the bones, to overcome an
external force.
• Power is the ability of the neuromuscular system to produce the greatest possible force
in the shortest possible time.
• Acute variables include repetitions, sets, training intensity, repetition tempo, rest
intervals, training volume, training frequency, training duration, exercise selection, and
exercise order.
• There are numerous training systems that can be used to structure resistance training
programs for a variety of effects. Several of the most common training systems include
warm-up set, single set, multiple set, pyramid, superset, complex training, drop set,
giant set, rest-pause set, circuit training, peripheral heart action, split routine, vertical
loading, and horizontal loading.
• Fitness professionals must safeguard their clients from harm. This requires maintaining
a safe environment, ensuring proper equipment set up, using appropriate spotting
procedures, and monitoring exercise technique using the five kinetic chain checkpoints.
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• Resistance exercises should initially focus on optimizing ideal movement patterns. Once
a client displays adequate movement competency, resistance exercises should progress
in a systematic fashion using three steps: (1) stabilization-focused exercises, (2)
strength-focused exercises, and (3) power-focused exercises.
Important Concepts (not an exhaustive list)
Stabilization The body’s ability to provide optimal dynamic joint support to maintain
correct posture during all movements.
Muscular endurance The ability to produce and maintain force production for prolonged
periods of time.
Muscular hypertrophy The enlargement of skeletal muscle fibers.
Strength The ability of the neuromuscular system to produce internal tension to
overcome an external load.
Power Force × Velocity or Work ÷ Time
Rate of force production Ability of muscles to exert maximal force output in a minimal amount of
time.
Suggested repetitions, Training Adaptation Suggested Acute Variables*
sets, and training intensity Stabilization and muscular • Moderate to high repetitions: ~12–
endurance 20 or higher
• Low to moderate sets: ~1–3 sets
• Low to moderate training intensities:
~50–70% 1RM
Muscular hypertrophy† • Low to moderate repetitions: ~6–12
or higher
• Moderate to high sets: ~3–6 sets
• Moderate to high training intensities:
~75–85% 1RM
Maximal strength • Low repetitions: ~1–5
• High sets: ~4–6 sets
• High training intensities: ~85–100%
1RM
Power • Low to moderate repetitions: ~1–10
• Moderate to high sets: ~3–6
• Low training intensities: ~10% of
bodyweight (when using a medicine
ball) or ~30–45% (when using
weights)
*The acute variables listed in this table are not absolutes. A client’s training program, goals, and
fitness level dictate appropriate acute variable selection.
† Muscle hypertrophy adaptations can be attained with various repetition, set, and intensity
schemes depending on the total volume of training and the client’s fitness level.
Resistance training Type Definition
systems Warm-up set 1–2 sets at a low intensity to psychologically and
physiologically prepare for the resistance training
exercise
Single set Performing one set of each exercise
Multiple set Performing a multiple number of sets for each
exercise
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Pyramid Increasing (or decreasing) weight with each set

Superset Performing two exercises in rapid succession with
minimal rest
Complex Performing a multijoint or compound exercise, with a
training heavy load, immediately followed by an explosive
movement (e.g., a barbell squat then a vertical jump)
Drop set Performing a set to failure, then removing a small
percentage of the load and continuing with the set
Giant set Performing four or more exercises in rotation with as
little rest as possible between sets
Rest pause Incorporating a slight pause between repetitions
within a series of sets
Circuit Performing a series of exercises, one after the other,
training with minimal rest
Peripheral A variation of circuit training that alternates upper
heart action and lower body exercises throughout the set
Split routine A resistance training routine that trains different
body parts on separate days
Vertical A form of training in which strength training exercises
loading**very are performed in rapid succession, starting with the
important upper body and working down to the lower body
(i.e., total-body → chest → back → shoulders →
biceps → triceps → legs)
Horizontal Performing all sets of an exercise (or body part)
loading**very before moving on to the next exercise (or body part)
important
Spotting checklist**very The following checklist should be used by the fitness professional during
important spotting activities:
• The spotter should regulate the number of total repetitions
performed by the client prior to the beginning of each set.
• The spotter should stand and maintain a stable, wide-stance body
position to increase maximal safety of the corresponding exercise.
• An experienced spotter delivers adequate and ample support for the
client to successfully execute the lift, especially when lifting through
the sticking point.
• The Certified Personal Trainer is encouraged to spot at the client’s
wrists instead of the elbows when using dumbbells (i.e., in a
dumbbell shoulder press). Spotting at the wrist provides better
support for the lifter and eliminates the elbows collapsing inward.
• During the barbell squat exercise, the spotter should be positioned
behind the lifter and place their upper arms underneath the lifter’s
armpits. This provides maximum spotting security between the
spotter and the lifter.
• The Certified Personal Trainer is encouraged to use an additional
spotter for exercises when the load surpasses what a single spotter
can successfully manage on their own. For example, two spotters
will stand on opposite sides of the barbell during a heavy barbell
back squat exercise. When and if needed, the spotters will assist the
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client in accomplishing the movements by lifting the ends of the

barbell until they are able to complete the exercise.
• It is not recommended for fitness professionals to spot machine-
based or cable-based exercises by placing their hands underneath
the weight stack. This increases risk of injury to the spotter and the
lifter.
Resistance training Progressive Volume
variables • Easy to hard • Sets
• Simple to complex • Low
• Static to dynamic
• Moderate
• Slow to fast
• Stabilization → strength → power
• High
• Repetitions
• Low
• Moderate
• High
Range of motion Planes of motion
• Full • Sagittal
• Partial • Frontal
• End range
• Transverse
• Mixed ranges
• Multiplanar
Speed of motion Resistance
• Slow • Body weight
• Medium • Light
• Fast
• Medium
• Explosive
• Heavy
Stabilization-focused This form of resistance training should provide greater demands on core
exercises stability and proprioception by progressing from bilateral to unilateral
movements, using slow repetition tempos, and high repetition schemes.
For example, the standing cable row can be progressed from two-arm
movements to alternating-arm movements to one-arm movements,
providing greater variety in one exercise.
Exercises can also be progressed in this category by decreasing one’s
base of support. For example, the same cable row sequence (two-arm,
alternating-arm, one-arm) can be advanced to a single-leg stance to
further challenge the client’s posture, balance, and joint stability.
Strength-focused These exercises focus on the adaptations of strength and muscular
exercises hypertrophy and typically require heavier loads than stabilization-
focused resistance exercises. The goal is to increase the amount of stress
placed on the body for increased muscle size and strength. This period of
training is a necessary progression from stabilization for anyone who
desires to increase muscle size, muscle strength, and bone mineral
density. Common exercises in this category include squats, Romanian
deadlifts, bench presses, and other common weightlifting exercises.
Power-focused exercises The last progression focuses on the adaptation of muscular power.
Power-focused resistance exercises are designed to increase the rate of
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force production (or speed of muscle contraction). This form of training

uses the adaptations of stabilization and strength acquired previously
and applies them with more realistic speeds and forces that the body
will encounter in everyday life and in sports. Examples of power-focused
resistance exercise include explosive movements, such as medicine ball
throws and explosive plyometrics.
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Section 6: Program Design

Chapter 21. The Optimum Performance Training Model
• Exercise programs need individuality, based on the client’s assessment results, to make
them impactful for clients, which likely increases adherence to the program.
• Fitness professionals should adopt an integrated, multicomponent approach to program
design that includes flexibility, cardiorespiratory, core, balance, plyometric, SAQ, and
resistance training.
• Exercise programs must consider many variables, such as teaching proper movement
patterns, improving mobility and stability, enhancing endurance, and reducing the
likelihood of injury.
• A training plan determines the forms of training to be used, how long it will take, how
often it will change, and what specific exercises will be performed.
• Periodization is a systematic approach to program design that varies the amount and
type of stress placed on the body to produce a physical adaptation and reduce the
likelihood of overtraining and injury.
• An annual training plan, or macrocycle, demonstrates the long-term training program
and how it progresses each month.
• A monthly training plan, or mesocycle, typically outlines a training plan for one month.
• A weekly plan, or microcycle, describes the specific workouts for the week.
• Linear periodization gradually increases the intensity of the training program while
simultaneously decreasing volume over a specific period of time.
• Undulating periodization uses changes in volume, intensity, and exercise selection to
provide loading differences on a daily or weekly basis.
• The OPT model consists of three levels: stabilization, strength, and power.
• The OPT model includes five unique phases of training: Phase 1 Stabilization Endurance
Training, Phase 2 Strength Endurance Training, Phase 3 Muscular Development Training,
Phase 4 Maximal Strength Training, and Phase 5 Power Training.
• The OPT workout template is divided into six parts: Warm-up, Activation, Skill
Development, Resistance Training, Client’s Choice, and Cool-down. Cardiorespiratory
training can be integrated into any section of the OPT template.
• Phase 1 Stabilization Endurance Training teaches clients how to perform proper
movement patterns, including pushing, pulling, pressing, squatting, hip hinging, trunk
rotation, and overall movement competency.
• Once clients display adequate movement patterns, Phase 1 programs are progressed by
placing a greater emphasis on enhancing proprioception, balance, and postural control.
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• Phase 2 Strength Endurance Training is a hybrid form of training that involves the use of
superset training in which a strength-focused exercise is immediately followed by a
stabilization-focused exercise with similar biomechanical motions.
• Phase 3 Muscular Development Training is designed to enhance muscle hypertrophy
using a high volume of strength-focused exercises.
• Phase 4 Maximal Strength Training requires the inclusion of heavy resistance training
exercises to increase muscular strength.
• Phase 5 Power Training uses superset techniques to increase rate of force production.
These superset techniques include performing a heavy resistance training exercise
immediately followed by an explosive power-based exercise with similar biomechanical
motions.
• The OPT model is an exercise program model that uses both linear and undulating
periodization to help clients of all levels and abilities achieve a variety of different goals,
including but not limited to reduced body fat, increased muscle mass, and improved
athletic performance.
Important Concepts (not an exhaustive list)
Phase 1 Sets Reps Tempo Rest Intensity
resistance 1-3 12-20 Slow 0-90 secs 12-20 RM
training **very important
protocols
Phase 2 Sets Reps Tempo Rest Intensity
resistance 2-4 8-12 Moderate 0-60 secs after 8-12 RM
training (strength) and each superset
protocols 8-12 Slow
(stability)
**very important
Phase 2 Strength-Focused Exercise Stability-Focused Exercise
example Bench press Push-up
superset sets Machine chest press Single-leg cable press
Machine lat pulldown Stading lat pulldown
Machine cable row Standing cable row
Machine shoulder press Standing bottoms-up kettlebell press
Seated dumbbell shoulder press Single-leg dumbbell shoulder press
Barbell squat Single-leg squat
Romanian deadlift Single-leg Romanian deadlift
Machine calf raise Single-leg calf raise
Phase 3 Sets Reps Tempo Rest Intensity
resistance 3-6 6-12 Moderate 0-3 minutes N/A
training Notes: 12-20 reps is allowed if additional muscular endurance is desired
protocols **very important
Phase 4 Sets Reps Tempo Rest Intensity
resistance 4-6 1-5 Explosive 0-3 minutes 1-5RM
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training **very important

protocols
Phase 5 Sets Reps Tempo Rest Intensity
resistance 3-5 1-5 (strength) Explosive 1-2 minutes 1-5RM
training and between and
protocols 8-10 (power) pairs; 3-5 8-10 RM, or
minutes 30-45% 1RM
between
circuits
**very important
Phase 5 Strength-Focused Exercise Power-Focused Exercise
example Bench press Medicine ball chest pass
superset sets Machine chest press Plyometric push-up
Machine lat pulldown Medicine ball soccer throw
Machine cable row Medicine ball pullover throw
Machine shoulder press Front medicine ball oblique throw
Seated dumbbell shoulder press Overhead medicine ball throw
Barbell squat Squat jump
Romanian deadlift Tuck jump

Chapter 22. Introduction to Exercise Modalities

● Exercise modalities are tools that are designed to enhance an exercise or movement to
create a desired outcome.
● There are many types of exercise modalities, including resistance training equipment,
balance tools, and fitness trackers.
● It is important to keep safety and effectiveness in mind when deciding which training
modalities may be the best to use and when to integrate them into a program.
● Because most novice exercisers lack resistance training experience, strength-training
machines may offer a safer and effective option to free weights. Strength-training
machines, however, are regarded as inferior to free weights for improving core stability
and muscular coordination, as they offer artificial support instead of using one’s core
musculature.
● Free weights can be used by most populations, in a variety of fashions, for many goals,
and in all phases of the OPT model. Although extremely versatile, free weights can be
intimidating for some clients.
● Cable machines can provide greater ROM when compared to selectorized strength
equipment. When using cable machines, it is important to match the cable’s resistance
to the muscle’s natural line of pull.
● Elastic bands and tubing also allow clients to perform resisted exercises that mimic
sport-specific movements, such as a golf swing or tennis forehand. Elastic resistance is
portable and inexpensive but may not be ideal when trying to develop high levels of
strength and muscular hypertrophy.
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● Medicine balls can be used like other resistance implements to add load or instability to
an exercise. Medicine balls can be used with a variety of populations as part of a
program to increase muscular strength, endurance, and power, or in some cases, to help
rehabilitate from injury.
● A kettlebell differs from a dumbbell, barbell, or medicine ball in that the center of mass
is away from the handle, which may require more strength and coordination, as well as
increased recruitment from stabilizers and prime movers simultaneously during
particular movements. Many kettlebell exercises involve multiple joint motions and
muscle groups.
● Suspended bodyweight training is an innovative approach to bodyweight fitness training
in that it uses a system of ropes and webbing that allows the user to work against their
own bodyweight while performing various exercises.
● Sandbags are designed to be carried, lifted, thrown, and pulled, and most come with
several handles to easily change grips. Unlike barbells, dumbbells, and selectorized
machines, the sand within the bag is constantly shifting, providing continuous instability.
● ViPR is an acronym for vitality, performance, and reconditioning. It is designed to be
dragged, tossed, lifted, pulled, pressed, and carried. This design provides the fitness
professional the ability to perform multidirectional, full-body exercises with external
load resistance, known as loaded movement training.
● Battle ropes are typically made of heavy-duty nylon and come in a variety of lengths and
thicknesses. Battle ropes are low-impact activities, which provide less impact on the
joints.
● Balance modalities improve balance, ankle stability, and coordination but should not be
used to perform maximal or near maximal lifts for safety reasons.
● Stability balls, also known as Swiss balls, are frequently used in a variety of training
facilities with a wide range of populations. They are primarily used to increase the
demand for stability in an exercise, but they can also be used to reinforce proper
posture during squatting movements.
● The BOSU ball is an inflated rubber hemisphere attached to a solid plastic surface; it
looks like a stability ball cut in half. Training with the BOSU ball offers the ability to
increase the intensity of an exercise by decreasing the stability.
● The Terra-Core is comprised of an inflatable rubber bladder and hard-surfaced backing.
Unlike stability balls, it is safe to perform several resistance training exercises, such as a
dumbbell chest press, while lying supine on the Terra-Core.
● Fitness trackers are electronic wearable devices that enable a user to track their activity
levels. They come in many forms, such as watches, bands, rings, heart rate monitors,
and pedometers. Ease of use and intrinsic motivation are key factors for continued use
of fitness trackers among those who purchase trackers.
Important Concepts (not an exhaustive list)
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Pros and Pros Cons

cons of May be less intimidating for certain clients Many machines do not allow the user to
strength perform total-body exercises
machines Can emphasize certain muscle groups for Moves primarily in one plane of motion
rehabilitation or bodybuilding purposes
Various intensities (load) provided in one Does little to provide challenge to the
weight stack core stabilization system
Does not require a spotter May not be ideal for improving athletic
performance
Provides extra support for clients with Machines do not fit all body types (short,
special needs tall, or obese clients may have a hard time
adjusting the machine)
Keeps the client in a fixed plane of Expensive in comparison to other
motion, which may limit excessive ranges strength-training modalities
of motion
Pros and Pros Cons
cons of free Can be used to emphasize certain May require a spotter
weights muscle groups or target multiple muscle
groups
Can improve athletic performance May be too difficult for beginning clients
to perform until exercise technique is
mastered
Can challenge the core stabilization Requires multiple dumbbells or barbells
system to change intensity (load)
May improve dynamic joint stabilization Potentially more dangerous
and proprioception
Allows individuals to move in multiple Intimidating for certain individuals
planes of motion

Chapter 23. Chronic Health Conditions and Special Populations

● There is a significant need for increased awareness and access to general fitness training
for youths year-round, not just during one or more sport seasons.
● Given the alarming increase in childhood obesity and diabetes, current youth fitness
guidelines focus on promoting healthy lifestyles and health-related physical fitness.
Current recommendations state that children and adolescents should get 60 minutes (1
hour) or more of moderate to vigorous physical activity daily.
● It is important to understand that there are fundamental physiologic differences
between children and adults.
● Research has clearly demonstrated that resistance training is both safe and effective in
children and adolescents.
● Despite the normal decline in physiologic functioning associated with aging, older
adults—with and without other chronic health conditions—can and do respond to
exercise much in the same manner as apparently healthy younger adults.
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● By adhering to a systematic process, fitness professionals can make a dramatic impact

on the overall health and well-being of older adults.
● Regular physical activity and exercise is one of the most important factors related to
long-term successful weight loss.
● Exercise has been shown to have a substantial positive effect on the treatment and
prevention of type 2 diabetes.
● Clients with stable coronary artery disease—especially those who have participated in a
cardiac rehabilitation program—should know or be taught information on the
importance and benefits of exercise, which include a lower risk of mortality, increased
exercise tolerance, muscle strength, reduction in angina and heart failure symptoms,
and improved psychological status and social adjustment.
● Exercise regimens that combine resistance training to increase BMD with flexibility,
core, and balance training to enhance proprioception are important for clients with
osteoporosis and osteopenia.
● It is important for fitness professionals to understand the difference between
rheumatoid arthritis and osteoarthritis and be aware of the signs and symptoms of an
acute rheumatoid arthritis exacerbation.
● Fitness professionals should also monitor the progress of clients with arthritis to assess
the effects of the exercise program on joint pain.
● Exercise is an important intervention for clients recovering from cancer. It can improve
exercise tolerance, reduce the cellular risks associated with cancer, and improve quality
of life.
● There has been substantial research documenting the beneficial effects of exercise
during pregnancy on the physiology and health of both the mother and developing
fetus.
● Clients with lung disease experience fatigue at low levels of exercise and often
experience dyspnea.
● The primary limiting factor for exercise in the client with PAD is leg pain.
Important Concepts (not an exhaustive list)
Exercise • Progression for the youth population should be based on postural control and
considerations not on the amount of weight that can be used
for youth • Make exercising fun
clients
Exercise • Progression should be slow, well monitored, and based on postural control.
considerations • Exercises should be progressed if possible, toward free sitting (no support) or
for older adults standing.
• Make sure the client is breathing in a normal manner and avoids holding their
breath, as in a Valsalva maneuver.
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• If the client cannot tolerate self-myofascial techniques or static stretches, they

can opt for slow and controlled active and dynamic stretches.
Exercise • Make sure client is comfortable—be aware of positions and locations in the
considerations facility your client is in.
for overweight • Exercises should be performed in a standing or seated position.
or obese • Clients may have other chronic diseases; in such cases, a medical release should
clients be obtained from the individual’s physician.
• Resistance exercises performed in a circuit-training manner, with higher
repetitions, such as 20, may be used if tolerated by the individual.
Exercise • Make sure client has appropriate footwear, and have client or physician check
considerations feet for blisters or abnormal wear patterns.
for diabetic • Advise client or class participant to keep a snack (quick source of carbohydrate)
clients available during exercise to avoid sudden hypoglycemia.
• Avoid excessive plyometric training, and higher-intensity training is not
recommended for clients with diabetes.
• Self-myofascial techniques may be contraindicated; a physician’s approval is
recommended.
Exercise • Avoid heavy lifting and Valsalva maneuvers—make sure client breathes
considerations normally.
for • Do not let client overgrip weights or clench fists when training.
hypertensive • Modify tempo to avoid extended isometric and concentric muscle actions.
clients • Perform exercises in a standing or seated position.
• Allow client to stand up slowly to avoid possible dizziness.
• Progress client slowly.
• Use circuit or peripheral heart action system (PHA) weight training as an option,
with appropriate rest intervals. Tempo should not exceed 1 second for
isometric and concentric portions of the lift.
Exercise • Be aware that clients may have other diseases to consider as well, such as
considerations diabetes, hypertension, peripheral vascular disease, or obesity.
for clients with • Modify tempo or pace to avoid extended isometric and concentric muscle
coronary heart actions.
disease • Avoid heavy lifting and Valsalva maneuvers—make sure client breathes
normally.
• Do not let client overgrip weights or clench fists when training.
• Perform exercises in a standing or seated position.
• Progress exercise slowly.
• Use circuit or peripheral heart action system (PHA) weight training as an option,
with appropriate rest intervals. Tempo should not exceed 1 second for
isometric and concentric portions of the lift.
Exercise • Progression should be slow, well monitored, and based on postural control.
considerations • Exercises should be progressed, if possible, toward free sitting (no support) or
standing.
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for clients with • Focus exercises on hips, thighs, back, and arms.
osteoporosis • Avoid excessive spinal loading on squat and leg press exercises.
• Make sure the client is breathing in normal manner and avoids holding their
breath, as in a Valsalva maneuver.
Exercise • Avoid heavy lifting and high repetitions. However, high repetitions with low
considerations load may be appropriate.
for arthritic • Stay in pain-free ranges of motion.
clients • Start out with only 5 minutes of exercise, if needed, and progressively increase,
depending on the severity of conditions.
• May use a circuit or peripheral heart action training system.
Exercise • Avoid heavy lifting in initial stages of training.
considerations • Allow for adequate rest intervals, and progress client slowly.
for clients with • There may be a need to start with only 5 minutes of exercise and progressively
cancer increase, depending on the severity of conditions and fatigue.
• May use a circuit or peripheral heart action training system.
Exercise • Avoid exercises in a prone (on stomach) or supine (on back) position after 12
considerations weeks of pregnancy.
for pregnant • Avoid self-myofascial techniques on varicose veins and areas of swelling.
clients • Plyometric training is not advised in the second and third trimesters.
• Moderate- to high-intensity resistance exercise may be used in the first
trimester if the client is accustomed to exercise; however, in the second and
third trimesters, lower-intensity exercise programs are advised.
Exercise • Upper-body exercises cause increased dyspnea and must be monitored.
considerations • Allow for sufficient rest between exercises.
for clients with • Peripheral heart action training system is recommended.
lung disease
Exercise • Allow for sufficient rest between exercises.
considerations • Workout may start with 5–10 minutes of activity.
for clients with • Slowly progress client.
intermittent • A circuit-training format is recommended.
claudication or
PAD